The great vessels or supra-aortic trunks (SATs) are most often affected by occlusive disease. Aneurysms of the SATs are much rarer compared with other vascular territories and may be associated with aneurysms or dissections of the ascending aorta and arch or aneurysms in other locations. Treatment of SAT aneurysms has evolved from ligation or exclusion to aneurysm resection with autogenous or prosthetic interposition grafts. There is now a growing body of literature describing the use of endovascular techniques to treat occlusive disease or SAT aneurysms. Hybrid techniques, which combine SAT revascularization by direct or cervical routes with aortic stenting, have also grown in popularity. This review covers anatomy, etiology and aortic arch pathology, clinical presentation, diagnosis, indications for treatment, open reconstruction for occlusive lesions, extrathoracic arterial reconstruction, aortic arch repair, endovascular treatment, and prosthetic SAT graft infection or involvement by tumor. Tables outline distribution of atherosclerotic lesions and extended carotid artery aneurysm studies from 2005 to 2012. Figures show a small subclavian artery aneurysm, thromboembolic occlusion of the brachial and forearm arteries, and digital infarcts; sternal exposure; multivessel supra-aortic trunk reconstruction; a subclavian to carotid artery transposition; three-dimensional relationships of a retropharyngeal and an anteriorly tunneled carotid-carotid bypass; an ascending aortic and total arch repair using an elephant trunk; distal arch and descending thoracic aortic aneurysms with chronic dissection treated with a hybrid technique; complex redo aortic coarctation and SAT reconstruction; hybrid repair of a developmental aortic arch abnormality, a large aberrant right subclavian aneurysm, and Kommerell diverticulum; infection of an ascending aortobilateral distal carotid prosthetic bypass graft originally placed for Takayasu arteritis; and an angiosarcoma involving the innominate, right subclavian, and cervical common carotid arteries and the internal jugular vein.
This review contains 11 figures, 2 tables, and 81 references.
A rare case of axillobifemoral bypass graft infection caused by Helicobacter cinaedi