Anomalous left vertebral artery from descending thoracic aorta with juxtaductal coarctation of aorta

Aim. Assessment of normal and variant aortic arch anatomy in patients with type A aortic dissection and aneurysm of the arch and descending thoracic aorta.Methods. We retrospectively studied computer tomography (CT) data of chest organs with contrast in patients who underwent reconstruction of the aortic arch in type I aortic dissection according to DeBakey classification (n = 61) and resection of the aortic arch and descending thoracic aorta aneurysm (n = 14) at the Meshalkin National Medical Research Center, Novosibirsk, Russian Federation. The control group included patients without aortic arch pathology (n = 52). To identify relationships between the anatomical type of aortic arch and the risk of aortic pathology development, univariate and multivariate binary logistic regression analyses were used.Results. Our analysis revealed four types of aortic arch anatomy. Normal aortic arch anatomy occurred in 66.1 % of patients (n = 84), the proportion of abnormalities of the left common carotid artery was 30 % (bovine aortic arch occurred in 15 %, and the same site of origin of left common carotid artery and brachiocephalic trunk occurred in 15 %). Divergence of the left vertebral artery from the aortic arch between the left common carotid and left subclavian arteries occurred in 3.1 % (n = 4), and the combination of “bovine trunk” and divergence of the left vertebral artery from the aortic arch was detected in 0.8 % patients (n = 1). Logistic regression analyses revealed no statistically significant relationships between variant aortic arch anatomy and the development of type A aortic dissections and aortic arch aneurysms. The presence of the common origin of brachiocephalic trunk and left common carotid artery was associated with a reduced risk of acute aortic dissection type I by 89 %, or an OR of 0.11 (95% CI: 0.03–0.46) (p = 0.002).Conclusion. Our data will help with future planning surgical interventions on the aortic arch and descending thoracic aorta.Received 17 June 2020. Revised 16 July 2020. Accepted 17 July 2020.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributions Conception and design: A.A. Shadanov Data collection and analysis: A.A. Shadanov, T.A. Bergen Statistical analysis: D.A. Sirota, A.A. Shadanov Drafting the article: A.A. Shadanov Critical revision of the article: D.A. Sirota, M.M. Lyashenko, A.M. Chernyavskiy Final approval of the version to be published: A.A. Shadanov, D.A. Sirota, T.A. Bergen, M.M. Lyashenko, A.M. Chernyavskiy

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1109 Huge aortic aneurysm after surgical repair of coarctation

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.655 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

M M De La Torre Carpente ◽

B Redondo Bermejo ◽

T M Perez Sanz ◽

M A Acuna Lorenzo ◽

M I Revilla Martinez ◽

...

Keyword(s):

Aortic Aneurysm ◽

Thoracic Aorta ◽

Subclavian Artery ◽

Lung Tissue ◽

Left Lung ◽

Aortic Aneurysms ◽

Coarctation Of Aorta ◽

Transverse Diameter ◽

Descending Thoracic Aorta ◽

Superior Lobe

Abstract A 51-year-old male presented to hospital with hemoptysis. The patient had been diagnosed of coarctation of the aorta and aortic aneurysm distal to the coarctation. In 1998 he underwent surgical correction with a a left subclavian artery bypass to the descending thoracic aorta and the aneurysm was excluded with a dacron graft. He denied hypertension. A thoracic CT performed during this episode, revealed a huge aneurysm in the descending thoracic aorta with a maximal transverse diameter of 13 cm and anteroposterior diameter of 13 cm. The length of the aneurysm was 11.5 cm. Inside the aneurysm there was a big thrombus with several peripheral layers of calcium. The vessel lumen had a diameter of 5.5 cm. The subclavian bypass had no stenosis. The right subclavian artery had an aberrant origen. The aneurysm compressed the left atrium, the left pulmonary artery, left lung tissue and the left main bronchus with a segmentary compressive atelectasis. There was a "ground-glass" pattern in the posterior region of the left superior lobe suggesting pulmonary bleeding. There was no evidence of enlargement of bronchial arteries. Neither were bronchiectasis. Thus, the patient was diagnosed of high suspicion of fistula between aorta and bronchi of the left superior lobe. He was referred to a centre specializing in treatment of coarctation and he was offered a debranching plus TEVAR procedure. Open surgery was not an option due to high risk. The patient refused the intervention. Discussion adults with aortic coarctation should undergo intervention when the gradient across the coarctation is greater than or equal to 20 mmHg and there is hypertension, when there is an altered blood pressure response during exercise or in case of hypertrophic left ventricle. Treatment options are surgery, stent and balloon angioplasty. Complications following intervention include recoarctation, aortic aneurysm, aortic dissection and hypertension. Therefore, it is mandatory to follow up these patients closely and regularly after an intervention either surgical or percutaneous. Digging up in our patient history we found a previous CT in 2009, at that moment transversal diameter of the aneurysm was 9.4 cm and the anteroposterior 12.4 cm. There were no more data after 2009 till 2019. Aortic aneurysms are a rare cause of hemoptysis with a very bad prognosis if not treated. Though CT and MR may suggest that there is a fistula, the aortography is the gold standard technique. Another mechanisms related to hemoptysis are the rupture of small vessels because of the compression of lung tissue or bronchial collapse with subsequent infection. In this case, maybe the big thrombus helped to avoid the rupture of the aneurysm into the left bronchi which would be fatal. Conclusion Patients with repaired coarctation of aorta should be followed regularly, whatever procedure is performed, because some of the complications following repair can have a bad prognosis. Abstract 1109 Figure. hugeaneurysmEuroEcho2019

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Management of thoracic aortic lesions - the future is endovascular

VASA ◽

10.1024/0301-1526/a000183 ◽

2012 ◽

Vol 41 (3) ◽

pp. 163-176 ◽

Cited By ~ 6

Author(s):

Weidenhagen ◽

Bombien ◽

Meimarakis ◽

Geisler ◽

A. Koeppel

Keyword(s):

Thoracic Aorta ◽

Clinical Decision Making ◽

Treatment Options ◽

Clinical Decision ◽

Clinical Results ◽

Treatment Modalities ◽

Traumatic Rupture ◽

Descending Thoracic Aorta ◽

New Treatment ◽

Aneurysm Dissection

Open surgical repair of lesions of the descending thoracic aorta, such as aneurysm, dissection and traumatic rupture, has been the state-of-the-art treatment for many decades. However, in specialized cardiovascular centers, thoracic endovascular aortic repair and hybrid aortic procedures have been implemented as novel treatment options. The current clinical results show that these procedures can be performed with low morbidity and mortality rates. However, due to a lack of randomized trials, the level of reliability of these new treatment modalities remains a matter of discussion. Clinical decision-making is generally based on the experience of the vascular center as well as on individual factors, such as life expectancy, comorbidity, aneurysm aetiology, aortic diameter and morphology. This article will review and discuss recent publications of open surgical, hybrid thoracic aortic (in case of aortic arch involvement) and endovascular repair in complex pathologies of the descending thoracic aorta.

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