Transposition of Isolated Left Vertebral Artery in Hybrid Thoracic Endovascular Aortic Repair

Overview

Journal Front Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2021 Dec 31

PMID 34970610

Citations 7

Authors

Guangmin Yang

Hongwei Chen

Guangxiao Sun

Wensheng Lou

Xin Chen

Leiyang Zhang

Affiliations

Soon will be listed here.

Abstract

The aim of this study was to present our experience with the management of isolated left vertebral artery (ILVA) during complex thoracic aortic pathology treated with the hybrid thoracic endovascular aortic repair. This is a single-center, respective cohort study. Between June 2016 and June 2020, 13 patients (12 men; median age 60 years old, range 42-72 years old) who underwent hybrid procedures were identified with ILVA in our center. Demographics, imaging features, operation details, and follow-up in these patients were collected and analyzed. In this study, all patients received the hybrid procedure, and the primary technical success rate was 100%. There were no in-hospital deaths. Complication occurred in two (15.4%) patients. One patient suffered from contrast-induced acute kidney injury (CI-AKI) and recovered before discharge. Another patient required reintervention for acute left-lower-limb ischemia, which was successfully treated using Fogarty catheter embolectomy. Immediate vagus/recurrent laryngeal never palsy, lymphocele, and chylothorax were not observed. The median duration of follow-up was 22 months (range, 13-29 months). No neurologic deficits, bypass occlusion, or ILVA occlusion or stenosis were observed during the follow-up. No aortic rupture, cerebrovascular accident, or spinal cord ischemia was observed during the follow-up period. Our limited experience reveals that hybrid procedures [thoracic endovascular aortic repair (TEVAR), ILVA transposition, and left common carotid artery-left subclavian artery (LCCA-LSA) bypass] are relatively safe, feasible, and durable for the treatment of thoracic aortic pathology with ILVA. However, further technique durability and larger studies with long-term follow-up periods are warranted.

Citing Articles

Antegrade Fenestration During Thoracic Endovascular Aortic Repair for Preserving Isolated Left Vertebral Artery.

Qiu X, Zeng Q, Shen P, Li D EJVES Vasc Forum. 2024; 62:93-96.

PMID: 39554909 PMC: 11565049. DOI: 10.1016/j.ejvsvf.2024.10.001.

Chyle leak after transposition of the aberrant left vertebral artery via 1-debranching thoracic endovascular aortic repair: a case report.

Nobuo K, Hodaka W, Yuta K, Kazuki K, Takahiro N, Kensuke O Gen Thorac Cardiovasc Surg Cases. 2024; 2(1):12.

PMID: 39517059 PMC: 11533701. DOI: 10.1186/s44215-023-00033-6.

A case of minimum invasive debranch thoracic endovascular aortic repair for isolated left vertebral artery: complete revascularization without artificial vessels via a single small incision.

Tsutsui M, Miyatani K, Shirakura K, Setogawa Y, Suzuki F, Miyamoto H J Surg Case Rep. 2024; 2024(10):rjae595.

PMID: 39376723 PMC: 11456828. DOI: 10.1093/jscr/rjae595.

Fenestrated Thoracic Endovascular Repair for Acute Type B Aortic Dissection with Isolated Left Vertebral Artery: A Case Report.

Yamada Y, Ohki T, Toya N, Ito E, Nakagawa H Ann Vasc Dis. 2024; 17(1):55-58.

PMID: 38628937 PMC: 11018099. DOI: 10.3400/avd.cr.23-00067.

Utilizing physician modified fenestration on the castor branched stent technique for reconstruction of an isolated left vertebral artery on the aortic arch.

Luo Z, Li S, Chen L, Huang R Sci Rep. 2024; 14(1):4051.

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References

van der Grond J, de Leeuw F, de Groot J, Algra A, Hillen B, Breteler M . Circle of Willis: morphologic variation on three-dimensional time-of-flight MR angiograms. Radiology. 1998; 207(1):103-11. DOI: 10.1148/radiology.207.1.9530305. View

Drinkwater S, Goebells A, Haydar A, Bourke P, Brown L, Hamady M . The incidence of spinal cord ischaemia following thoracic and thoracoabdominal aortic endovascular intervention. Eur J Vasc Endovasc Surg. 2010; 40(6):729-35. DOI: 10.1016/j.ejvs.2010.08.013. View

Sun L, Qi R, Chang Q, Zhu J, Liu Y, Yu C . Is total arch replacement combined with stented elephant trunk implantation justified for patients with chronic Stanford type A aortic dissection?. J Thorac Cardiovasc Surg. 2009; 138(4):892-6. DOI: 10.1016/j.jtcvs.2009.02.041. View

Katsanos A, Kosmidou M, Kyritsis A, Giannopoulos S . Is vertebral artery hypoplasia a predisposing factor for posterior circulation cerebral ischemic events? A comprehensive review. Eur Neurol. 2013; 70(1-2):78-83. DOI: 10.1159/000351786. View

Tanaka H, Fujita N, Enoki T, Matsumoto K, Watanabe Y, Murase K . Relationship between variations in the circle of Willis and flow rates in internal carotid and basilar arteries determined by means of magnetic resonance imaging with semiautomated lumen segmentation: reference data from 125 healthy volunteers. AJNR Am J Neuroradiol. 2006; 27(8):1770-5. PMC: 8139760. View

Celikyay Z, Koner A, Celikyay F, Deniz C, Acu B, Firat M . Frequency and imaging findings of variations in human aortic arch anatomy based on multidetector computed tomography data. Clin Imaging. 2013; 37(6):1011-9. DOI: 10.1016/j.clinimag.2013.07.008. View

Ohkura K, Shiiya N, Washiyama N, Yamashita K, Takahashi D, Tsuda K . Vertebral artery variations in thoracic aortic patients. Eur J Cardiothorac Surg. 2014; 46(1):27-31. DOI: 10.1093/ejcts/ezt609. View

Li Q, Li J, Lv F, Li K, Luo T, Xie P . A multidetector CT angiography study of variations in the circle of Willis in a Chinese population. J Clin Neurosci. 2011; 18(3):379-83. DOI: 10.1016/j.jocn.2010.07.137. View

Czerny M, Schmidli J, Adler S, van den Berg J, Bertoglio L, Carrel T . Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular.... Eur J Cardiothorac Surg. 2018; 55(1):133-162. DOI: 10.1093/ejcts/ezy313. View

10.

Dumfarth J, Chou A, Ziganshin B, Bhandari R, Peterss S, Tranquilli M . Atypical aortic arch branching variants: A novel marker for thoracic aortic disease. J Thorac Cardiovasc Surg. 2015; 149(6):1586-92. DOI: 10.1016/j.jtcvs.2015.02.019. View

11.

Yamashiro S, Kuniyoshi Y, Arakaki K, Inafuku H, Morishima Y, Kise Y . Total arch replacement with associated anomaly of the left vertebral artery. Ann Thorac Cardiovasc Surg. 2010; 16(3):216-9. View

12.

Qi R, Sun L, Zhu J, Liu Y, Zheng J, Li C . Total arch replacement in patients with aortic dissection with an isolated left vertebral artery. Ann Thorac Surg. 2012; 95(1):36-40. DOI: 10.1016/j.athoracsur.2012.07.078. View

13.

Tapia G, Zhu X, Xu J, Liang P, Su G, Liu H . Incidence of branching patterns variations of the arch in aortic dissection in Chinese patients. Medicine (Baltimore). 2015; 94(17):e795. PMC: 4603058. DOI: 10.1097/MD.0000000000000795. View

14.

Bradshaw R, Ahanchi S, Powell O, Larion S, Brandt C, Soult M . Left subclavian artery revascularization in zone 2 thoracic endovascular aortic repair is associated with lower stroke risk across all aortic diseases. J Vasc Surg. 2017; 65(5):1270-1279. DOI: 10.1016/j.jvs.2016.10.111. View

15.

Naito Y, Nakajima M, Inoue H, Mizutani E, Tsuchiya K . Successful treatment of a mycotic aortic arch aneurysm associated with an isolated left vertebral artery. J Thorac Cardiovasc Surg. 2003; 126(3):883-5. DOI: 10.1016/s0022-5223(03)00714-1. View

16.

Ding H, Zhu Y, Wang H, Luo S, Liu Y, Huang W . Management of type B aortic dissection with an isolated left vertebral artery. J Vasc Surg. 2019; 70(4):1065-1071. DOI: 10.1016/j.jvs.2018.11.052. View

17.

Popieluszko P, Henry B, Sanna B, Hsieh W, Saganiak K, Pekala P . A systematic review and meta-analysis of variations in branching patterns of the adult aortic arch. J Vasc Surg. 2017; 68(1):298-306.e10. DOI: 10.1016/j.jvs.2017.06.097. View

18.

Lazaridis N, Piagkou M, Loukas M, Piperaki E, Totlis T, Noussios G . A systematic classification of the vertebral artery variable origin: clinical and surgical implications. Surg Radiol Anat. 2018; 40(7):779-797. DOI: 10.1007/s00276-018-1987-3. View

19.

Piffaretti G, Gelpi G, Tadiello M, Ferrarese S, Socrate A, Tozzi M . Transposition of the left vertebral artery during endovascular stent-graft repair of the aortic arch. J Thorac Cardiovasc Surg. 2019; 159(6):2189-2198.e1. DOI: 10.1016/j.jtcvs.2019.06.011. View

20.

Conway A, Qato K, Nhan Nguyen Tran N, Giangola G, Carroccio A . Management of the Left Subclavian Artery in TEVAR for Chronic Type B Aortic Dissection. Vasc Endovascular Surg. 2020; 54(7):586-591. DOI: 10.1177/1538574420942353. View