Management of a Right Aberrant Subclavian Artery during Complex Hybrid Stent-Graft Procedures: A Rare and Complex Issue

2007 ◽  
Vol 2 (1) ◽  
pp. 48-50
Author(s):  
Siamak Mohammadi ◽  
Jean-Pierre Normand ◽  
Roch Turcotte ◽  
Pierre Voisine ◽  
Patrick Mathieu ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Stent Graft ◽  
Subclavian Artery ◽  
Elephant Trunk ◽  
Aberrant Subclavian Artery ◽  
Aortic Replacement ◽  
Descending Aortic Aneurysm ◽  
Complex Hybrid ◽  
The Right

A 76-year-old man with an ascending arch and proximal descending aortic aneurysm underwent a complex aortic replacement through a sternotomy with ligation of a right aberrant subclavian artery (RASA) distal to the right vertebral artery. The second-stage procedure was performed with a stent-graft deployed within the elephant trunk. At 6- and 12-month follow-up, the RASA was opacified by the patent right vertebral artery. Under ultrasound guidance, the patient's RASA stump was occluded by coils. Management of an RASA during complex hybrid stent-graft procedures is discussed.

Management of a Right Aberrant Subclavian Artery during Complex Hybrid Stent-Graft Procedures: A Rare and Complex Issue

2007 ◽  
Vol 2 (1) ◽  
pp. 48-50
Author(s):  
Siamak Mohammadi ◽  
Jean-Pierre Normand ◽  
Roch Turcotte ◽  
Pierre Voisine ◽  
Patrick Mathieu ◽  
...  
Keyword(s):  
Stent Graft ◽  
Subclavian Artery ◽  
Complex Issue ◽  
Aberrant Subclavian Artery ◽  
Complex Hybrid

scholarly journals Combination of Rare Right Arterial Variation with Anomalous Origins of the Vertebral Artery, Aberrant Subclavian Artery and Persistent Trigeminal Artery

2011 ◽  
Vol 17 (3) ◽  
pp. 339-342 ◽  
Author(s):  
H. Ishihara ◽  
D. San Millán Ruíz ◽  
G. Abdo ◽  
F. Asakura ◽  
H. Yilmaz ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Vertebral Artery ◽  
Subclavian Artery ◽  
Persistent Trigeminal Artery ◽  
Trigeminal Artery ◽  
Arterial Variation ◽  
Descending Aorta ◽  
Aberrant Subclavian Artery ◽  
The Right

A 32-year-old woman hospitalized for subarachnoid hemorrhage showed rare arterial variation on the right side with anomalous origins of the vertebral artery, aberrant subclavian artery and persistent trigeminal artery. Angiography showed the right vertebral artery to originate from the right common carotid artery, the right subclavian artery to arise separately from the descending aorta, and persistent trigeminal artery on the right side. The possible embryonic mechanism of this previously unreported variant combination is discussed.

Complications after Endovascular Repair of Type B Aortic Dissection

2002 ◽  
Vol 9 (6) ◽  
pp. 822-828 ◽  
Author(s):  
Reinhard S. Pamler ◽  
Thomas Kotsis ◽  
Johannes Görich ◽  
Xaver Kapfer ◽  
Karl-Heinz Orend ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Stent Grafting ◽  
Stent Graft Implantation ◽  
Graft Implantation

Purpose: To outline the complications encountered after endoluminal treatment in patients with type B aortic dissection. Methods: Between 1999 and 2001, 14 patients (12 men; mean age 60.3 years, range 39–79) with isolated type B aortic dissection (13 chronic, 1 acute) underwent aortic stent-grafting. Three patients with chronic dissection presented an acute clinical picture and were managed emergently. The left subclavian artery was intentionally covered by the prosthesis in 9 patients. Follow-up studies were performed at 6-month intervals. Results: Stent-graft implantation was technically successful in all patients, but incomplete sealing (endoleak) of the entry site required additional proximal stent-graft implantation in 4. The left subclavian artery remained patent in 5 patients. Secondary conversion was required in 3 patients: 2 for acute type A dissection resulting from injury to the aortic arch by Talent endografts and a sustained hemorrhage (left hemothorax). In another patient, a secondary intramural hematoma subsided spontaneously. Anterior spinal artery syndrome in 1 patient persisted at 1 month. No bypass was necessary for the 9 patients with the covered left subclavian arteries. Mean follow-up was 14 months (range 1–23). Conclusions: Stent-grafting is feasible in patients with type B aortic dissection, although it is associated with a considerable rate of complications. Frank reporting of these sequelae for a variety of stent-grafts is of paramount importance to clarifying the limitations of the method.

Non-Standard Management of Target Vessels With the Inner Branch Arch Endograft: A Single-Center Retrospective Study

2021 ◽  
pp. 152660282110586
Author(s):  
Jose I. Torrealba ◽  
Konstantinos Spanos ◽  
Giuseppe Panuccio ◽  
Fiona Rohlffs ◽  
Thomas Gandet ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Vertebral Artery ◽  
Subclavian Artery ◽  
False Lumen ◽  
Aberrant Right Subclavian Artery ◽  
Left Vertebral Artery ◽  
Type I ◽  
Single Center ◽  
Standard Management

Purpose: The purpose of this study was to evaluate early and mid-term results of non-standard management of the supraaortic target vessels with the use of the inner branch arch endograft in a single high-volume center. Material and methods: A single-center retrospective study including all patients undergoing implantation of an inner branch arch endograft from December 2012 to March 2021, who presented a non-standard management of the supraaortic target vessels (any bypass other than a left carotid-subclavian or landing in a dissected target vessel). Technical success, mortality, reinterventions, endoleak (EL), and aortic remodeling at follow-up were analyzed. Results: Twenty-four patients were included. In 17 (71%) cases, the non-standard management was related to innominate artery (IA) compromise (12 with IA dissection, 2 with short IA, 2 with short proximal aortic landing zone that required occlusion of IA, 1 with occluded IA after open arch repair). Two (8%) cases were related to an aberrant right subclavian artery (RSA), 1 patient (4%) due to the concomitant presence of a left vertebral artery (LVA) arising from the arch and an occluded left subclavian artery (LSA), and another patient presented with an occluded LSA distal to a dominant vertebral artery. Three (13%) cases were exclusively related to management in patients with genetic aortic syndromes. Twenty (83%) patients had a previous type A aortic dissection. Ten (42%) patients presented a thoracic or thoracoabdominal aortic aneurysm and 8 (33%) patients an arch aneurysm, 6 of them associated to false lumen (FL) perfusion. There were 2 (8%) perioperative minor strokes, and 1 patient with perioperative mortality. Seven patients presented an early type I endoleak, all resolved at follow-up. Seven patients required reinterventions during follow-up (7 reinterventions related to continuous false lumen perfusion, 3 related to Type Ia endoleak, 2 related to surgical bypass). All patients who presented with FL perfusion had complete FL thrombosis at follow-up. No patient presented aneurysm growth at follow-up. Conclusions: The use of the inner branch arch endograft with a non-standard management of the supraaortic target vessels is a possible option. Despite a high reintervention rate, regression or stability of the aneurysmal diameter was achieved in all the patients with follow-up.

scholarly journals Intractable Scapular Pain Due to Undiagnosed Osteoid Osteoma: A Case Report

2020 ◽  
Vol 11 (03) ◽  
pp. 489-491
Author(s):  
Karthika Veerapaneni ◽  
Poornachand Veerapaneni ◽  
Nidhi Kapoor ◽  
Rohan S Samant ◽  
Sisira Yadala ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Osteoid Osteoma ◽  
Diagnostic Testing ◽  
Mass Effect ◽  
Decompression Surgery ◽  
Tissue Mass ◽  
Neurology Clinic ◽  
Radiolucent Lesion ◽  
The Right

AbstractA 36-year-old female patient presented to our stroke neurology clinic for progressively worsening intractable, sharp, shooting interscapular pain radiating to the right shoulder and neck, which she had experienced for 4 years. She had previously seen an orthopedist and was referred to a neurosurgeon for surgical intervention after an MRI of the cervical spine showed the C3–C4 right vertebral artery loop protruding into the right C3–C4 neural foramen and compressing the exiting C4 nerve root. MR neurography showed a stable tortuous right vertebral artery loop, causing a mass effect on the dorsal root ganglion. A neuroforaminal decompression surgery was planned. However, the patient visited our stroke neurology clinic for a second opinion before surgery. An MRI of the thoracic spine showed an enhancing soft tissue mass at the right T4–T5 pedicles and adjacent body. A chest CT with contrast showed a 1 cm radiolucent lesion in the superior articular facet of T5, which represented a nidus. A technetium bone scan showed focal increased uptake within the right T5 pedicle, which is indicative of osteoid osteoma. The patient underwent laminectomy/resection and was pain-free at a 6-month follow-up; biopsy confirmed osteoid osteoma. This case illustrates the importance of neurolocalization during diagnostic testing.

scholarly journals Type B aortic dissection repair using a Thoraflex hybrid prosthesis in a setting of aberrant left vertebral artery

2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
Saifullah Mohamed ◽  
Akshay J Patel ◽  
Yassir Iqbal ◽  
Khurum Mazhar ◽  
Uday Dandekar ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Vertebral Artery ◽  
Left Vertebral Artery ◽  
Type B ◽  
Frozen Elephant Trunk ◽  
Type B Aortic Dissection ◽  
Elephant Trunk ◽  
Aortic Replacement ◽  
Increased Risk ◽  
Hybrid Prosthesis

Abstract Type B aortic dissection (TBAD) is often managed conservatively with intervention reserved for complicated cases. Strategies for complicated and uncomplicated TBAD can involve optimal medical therapy, thoracic endovascular aortic replacement and open surgical repair of TBAD with replacement of the affected segment of aorta and reimplantation of aortic branches. The frozen elephant trunk technique has been reported to be a successful surgical strategy in patients with complicated TBAD, particularly in patients who possess unfavourable aortic arch anatomy for endovascular stenting or at increased risk of retrograde Type A aortic dissection. The Thoraflex is a commercially available aortic graft, manufactured by Vascutek®. We describe a successful case of addressing complicated TBAD with rare variant aortic anatomy using a Thoraflex hybrid frozen elephant trunk graft and reimplantation of the aberrant left vertebral artery to the perfusion limb of the Thoraflex graft.

scholarly journals Treatment with Aortic Stent Graft Placement for Stanford B-Type Aortic Dissection in a Patient with an Aberrant Right Subclavian Artery

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Yohei Kawatani ◽  
Yujiro Hayashi ◽  
Yujiro Ito ◽  
Hirotsugu Kurobe ◽  
Yoshitsugu Nakamura ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Subclavian Artery ◽  
Distal Portion ◽  
Aberrant Right Subclavian Artery ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Aortic Stent Graft ◽  
The Right ◽  
Stanford Type B

A 71-year-old man visited our hospital with the chief complaint of back pain and was diagnosed with acute aortic dissection (Debakey type III, Stanford type B). He was found to have a variant branching pattern in which the right subclavian artery was the fourth branch of the aorta. We performed conservative management for uncomplicated Stanford type B aortic dissection, and the patient was discharged. An ulcer-like projection (ULP) was discovered during outpatient follow-up. Complicated type B aortic dissection was suspected, and we performed thoracic endovascular aortic repair (TEVAR). The aim of operative treatment was ULP closure; thus we placed two stent grafts in the descending aorta from the distal portion of the right subclavian artery. The patient was released without complications on postoperative day 5. Deliberate sizing and examination of placement location were necessary when placing the stent graft, but operative techniques allowed the procedure to be safely completed.

Suturing Fenestration of the Left Subclavian Artery Orifice in Frozen Elephant Trunk Procedure

2020 ◽  
Author(s):  
Mitsumasa Hata ◽  
Shinji Wakui ◽  
Yusuke Ishii ◽  
Rei Hinoura ◽  
Susumu Isaka ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Stent Graft ◽  
Subclavian Artery ◽  
Distal Part ◽  
Left Subclavian Artery ◽  
Frozen Elephant Trunk ◽  
Bleeding Events ◽  
Elephant Trunk ◽  
Novel Technique ◽  
Elephant Trunk Procedure

AbstractThe frozen elephant trunk (FET) procedure enables easier replacement of the entire aortic arch because it does not require reaching the distal part of the left subclavian artery (LSCA). However, it requires additional management for reconstruction of the LSCA, which is associated with bleeding events. However, the fenestrated FET technique confers a risk of endoleakage from the fenestration site. We report our unique novel technique in which the proximal side of the hybrid stent graft is cut into V-shape around the subclavian artery and sutured continuously around the orifice of the subclavian artery during aortic stump fixation.

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