Surgical approach to complicated cervical aortic arch: anatomic, developmental, and surgical considerations

2000 ◽  
Vol 10 (3) ◽  
pp. 212-219 ◽  
Author(s):  
Doff B. McElhinney ◽  
LeNardo D. Thompson ◽  
Paul M. Weinberg ◽  
Kenneth L. Jue ◽  
Frank L. Hanley
Keyword(s):  
Aortic Arch ◽  
Vascular Tissue ◽  
Perioperative Complications ◽  
Vascular Ring ◽  
Median Sternotomy ◽  
Descending Aorta ◽  
Direct Anastomosis ◽  
Arch Obstruction ◽  
Structural Anomalies

AbstractBackgroundAbnormalities of brachiocephalic arterial branching and arch laterality are common in patients with a cervical aortic arch. In addition, structural anomalies of the arch such as obstruction, aneurysms, and tortuosity are found in a significant number of cases.MethodsBetween 1990 and 1998, 6 patients underwent surgery for an obstructed right cervical arch. A significant obstruction was present at the transverse or distal arch in all patients, and was recurrent after previous repair in 2. In 1 patient, there was also a multi-lobed aneurysm of the aortic segment contiguous to the obstruction, and in 2 there was marked tortuosity of the arch. In all cases, the order of origin of the head and neck vessels was abnormal, and obstruction of 1 or more brachiocephalic vessels was found in 3. A vascular ring was present in all patients, with a right aortic arch and aberrant left subclavian artery in 4 patients and a double aortic arch with a dominant right cervical arch in 2. The descending aorta was circumflex (left-sided) in 3 patients. Three patients were repaired through a standard right posterolateral thoracotomy, and 3 through a median sternotomy. Patch augmentation aortoplasty was used in 2 patients, a tube graft from the ascending to descending aorta in 2, end to side anastomosis of the descending aorta to the proximal arch in 1, and direct anastomosis to reconstruct an atretic left-sided component of a double arch in 1.ResultsRepair was successful in all cases, with no perioperative complications. At follow-up ranging from 1 to 9 years, all patients were alive and well, with no recurrence of arch obstruction or other significant complications. Fluorescentin situhybridization revealed microdeletion of chromosome 22q 11 in 1 patient (not performed in the others).ConclusionsStructural anomalies of the arch are relatively common in patients with a cervical aortic arch. Such abnormalities may be the result of hemodynamic conditions and/or abnormal vascular tissue related either to the cervical position of the arch or its embryologic precursors. Given the highly variable anatomy of patients with a complicated cervical aortic arch, surgical considerations will vary in kind.

Surgical Management of Right Aortic Arch Obstruction Associated With Rare Form of Vascular Ring

2020 ◽  
Vol 11 (2) ◽  
pp. 222-225
Author(s):  
Evgeny V. Krivoshchekov ◽  
Frank Cetta ◽  
Oleg A. Egunov ◽  
Evgenii A. Sviazov ◽  
Valeriy O. Kiselev ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Surgical Management ◽  
Rare Case ◽  
Vascular Ring ◽  
Right Aortic Arch ◽  
Rare Form ◽  
Descending Aorta ◽  
Arch Obstruction ◽  
Right Descending Aorta

This clinical case demonstrated surgical management for a rare case of vascular ring associated with an elongated and kinked aortic arch and a right descending aorta in a ten-year-old male using an extra-anatomic bypass grafting method and dividing the vascular ring. Computer tomography performed at six-month follow-up showed a favorable surgical outcome.

Repair of Rare Vascular Ring: Circumflex Aortic Arch with Associated Hypoplasia and Coarctation

2019 ◽  
Vol 11 (2) ◽  
pp. 235-237
Author(s):  
David C. Mauchley ◽  
Julia Massey Stiegler ◽  
Luz A. Padilla ◽  
Zviadi Aburjania ◽  
Robet Dabal ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Ductus Arteriosus ◽  
Vascular Ring ◽  
Median Sternotomy ◽  
Surgical Correction ◽  
Descending Aorta ◽  
Aberrant Left Subclavian Artery

We describe a neonate with an unusual vascular ring formed by a right-sided aortic arch with associated coarctation and distal hypoplasia in the presence of an aberrant left subclavian artery. The descending aorta traveled behind the esophagus to descend on the left side of the spine. A left ductus arteriosus connected to the descending aorta completing the vascular ring, with notable esophageal compression. Surgical correction was accomplished through median sternotomy, resection of the hypoplastic circumflex arch, aortic arch advancement, and end-to-side anastomosis.

Aortic Relocation for Transposition Complex with Aortic Arch Obstruction

2009 ◽  
Vol 17 (4) ◽  
pp. 422-424 ◽  
Author(s):  
Atsushi Tateishi ◽  
Masaaki Kawada ◽  
Hideki Morita ◽  
Shingo Kasahara ◽  
Shunji Sano
Keyword(s):  
Aortic Arch ◽  
Primary Repair ◽  
Ascending Aorta ◽  
Anomalous Coronary Artery ◽  
Descending Aorta ◽  
Direct Anastomosis ◽  
Size Discrepancy ◽  
Arch Obstruction ◽  
Significant Size ◽  
Anomalous Coronary

We describe successful primary repair of 2 cases of transposition complex with aortic arch obstruction. A new aortic arch was reconstructed by direct anastomosis between the well-mobilized ascending aorta and the descending aorta. The neoaortic root with transferred coronary arteries was subsequently anastomosed to the undersurface of this new aortic arch. This technique deals with the significant size discrepancy between the 2 great arteries, and anomalous coronary artery patterns.

scholarly journals Antegrade transapical branch deployment for endovascular aortic-arch repair by in situ fenestration

2019 ◽  
Author(s):  
Takashi Murakami ◽  
Noriaki Kishimoto ◽  
Etsuji Sohgawa ◽  
Toshihiko Shibata
Keyword(s):  
Aortic Arch ◽  
Carotid Arteries ◽  
Stent Grafts ◽  
Descending Aorta ◽  
Bilateral Carotid ◽  
Aortic Arch Repair ◽  
Sheath Insertion ◽  
Arch Aneurysm ◽  
Transapical Access

Abstract A 76-year-old man presented with an aortic arch aneurysm and was considered a candidate for endovascular aortic arch repair by in situ fenestration. Alternative access routes were explored because of atherosclerotic disease of the descending aorta and bilateral carotid arteries. Transapical deployment of both an aortic and a branched stent grafts was successfully conducted without cerebral complications. The transapical access might have the potential to reduce the risks of complications related to large bore-sheath insertion to the carotid arteries.

scholarly journals Novel hybrid treatment for extensive aortic arch aneurysms, a case report

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Mixia Li ◽  
Hulin Piao ◽  
Yong Wang ◽  
Kexiang Liu
Keyword(s):  
Aortic Arch ◽  
Median Sternotomy ◽  
Single Stage ◽  
Hybrid Surgery ◽  
Case Presentation ◽  
Descending Aorta ◽  
Hybrid Treatment ◽  
Hybrid Repair ◽  
Arch Aneurysm ◽  
Very High

Abstract Background The treatment for extensive aortic arch aneurysms involving the aortic arch and descending aorta is challenging for most cardiovascular surgeons. The surgical treatment is associated with a very high mortality rate. The optimal treatment has not been defined. Case presentation A 49-year-old male was hospitalized due to chest and upper back pain. Computed tomography angiography (CTA) demonstrated there was an extensive aortic arch aneurysm extending to the left common carotid artery and descending aorta. A novel single- stage hybrid surgery was performed on the patient through two steps: treatment of the aortic arch through median sternotomy and thoracic endovascular artery repair. The patient recovered uneventfully. Conclusions Our single-stage hybrid repair approach is safe, simple and effective. It provides an alternative treatment for extensive aortic arch aneurysms.

A vascular ring: right aortic arch and descending aorta with left ductus arteriosus

2001 ◽  
Vol 71 (2) ◽  
pp. 729-731 ◽  
Author(s):  
Jae Jin Han ◽  
Sejung Sohn ◽  
Hae Soon Kim ◽  
Tae Hee Won ◽  
Jae Ho Ahn
Keyword(s):  
Aortic Arch ◽  
Ductus Arteriosus ◽  
Vascular Ring ◽  
Right Aortic Arch ◽  
Descending Aorta

Surgical Repair of Double Aortic Arch: 16-Year Experience

2005 ◽  
Vol 13 (1) ◽  
pp. 4-10 ◽  
Author(s):  
Ganesh Shanmugam ◽  
Kenneth Macarthur ◽  
James Pollock
Keyword(s):  
Aortic Arch ◽  
Surgical Repair ◽  
Surgical Complication ◽  
Vascular Ring ◽  
Symptomatic Relief ◽  
Median Sternotomy ◽  
High Risk Group ◽  
Double Aortic Arch ◽  
Long Term Results ◽  
Persistent Symptoms

Double aortic arch (DAA) is a complete form of vascular ring causing tracheoesophageal compression. We analyzed long-term results of a series of DAAs, over a period of 16 years. Between 1987 and 2003, 29 children underwent surgery for airway and/or esophageal compression secondary to a DAA. Dominant symptoms were stridor, dysphagia, choking episodes, and life-threatening apneic spells ( n = 7). Diagnosis was established by barium studies, bronchoscopy, echocardiogram, angiogram, computed tomography (CT), and magnetic resonance imaging (MRI). Seven patients had concurrent cardiac anomalies. Two children had an associated tracheoesophageal fistula. Surgery was accomplished by left thoracotomy ( n = 25), right thoracotomy ( n = 2) or median sternotomy ( n = 2). The operative mortality was zero. There was one late death due to respiratory failure. Four (13.8%) patients had a surgical complication (chylothorax, 3 cases; acute renal failure, 1 case). Follow-up (mean 7.1 years; range 6 months to 16 years) was complete in all patients, and showed complete improvement in 22 patients and partial improvement in 6 patients. Early surgical repair of DAA is associated with low mortality, and results in marked symptomatic relief in most patients. Patients with tracheomalacia or associated asthma, constitute a high-risk group and may manifest persistent symptoms and require adjunctive procedures.

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