Less-invasive management of left subclavian artery in stent-grafting for distal aortic arch disease

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.

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eComment. Right cervical aortic arch and aberrant left subclavian artery

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivu198 ◽

2014 ◽

Vol 19 (2) ◽

pp. 333-333

Author(s):

Jose Aramendi

Keyword(s):

Aortic Arch ◽

Subclavian Artery ◽

Left Subclavian Artery ◽

Aberrant Left Subclavian Artery

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Surgical left subclavian artery revascularization for thoracic aortic stent grafting: a single-centre experience in 101 patients†

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivy059 ◽

2018 ◽

Vol 27 (2) ◽

pp. 284-289 ◽

Cited By ~ 11

Author(s):

Emma van der Weijde ◽

Nabil Saouti ◽

Jan Albert Vos ◽

Selma C Tromp ◽

Robin H Heijmen

Keyword(s):

Subclavian Artery ◽

Left Subclavian Artery ◽

Single Centre ◽

Stent Grafting ◽

Single Centre Experience

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Anatomical Variations in the Branching Pattern of Human Aortic Arch: A Cadaveric Study from Central India

ISRN Anatomy ◽

10.5402/2013/828969 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Virendra Budhiraja ◽

Rakhi Rastogi ◽

Vaishali Jain ◽

Vishal Bankwar ◽

Shiv Raghuwanshi

Keyword(s):

Carotid Artery ◽

Vertebral Artery ◽

Aortic Arch ◽

Subclavian Artery ◽

Common Carotid Artery ◽

Left Subclavian Artery ◽

Left Vertebral Artery ◽

Common Trunk ◽

Branching Pattern ◽

Brachiocephalic Trunk

Variations of the branches of aortic arch are due to alteration in the development of certain branchial arch arteries during embryonic period. Knowledge of these variations is important during aortic instrumentation, thoracic, and neck surgeries. In the present study we observed these variations in fifty-two cadavers from Indian populations. In thirty-three (63.5%) cadavers, the aortic arch showed classical branching pattern which includes brachiocephalic trunk, left common carotid artery, and left subclavian artery. In nineteen (36.5%) cadavers it showed variations in the branching pattern, which include the two branches, namely, left subclavian artery and a common trunk in 19.2% cases, four branches, namely, brachiocephalic trunk, left common carotid artery, left vertebral artery, and left subclavian artery in 15.3% cases, and the three branches, namely, common trunk, left vertebral artery, and left subclavian artery in 1.9% cases.

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