Ascending aorta and aortic root replacement in an infant: a case report

We herein report the first clinical case of prosthetic replacement of the ascending aorta and aortic arch to repair a giant aneurysm in a 7-month-old child. The ascending aorta and arch replacement to the level of left subclavian artery was performed using a no. 16 Polymaille prosthesis, the brachiocephalic trunk was reimplanted into the vascular prosthesis and the kinked section of the left common carotid artery was removed, followed by reimplanting the left common carotid artery into the left subclavian artery. First, proximal anastomosis with the vascular prosthesis was created using a no. 16 Polymaille prosthesis and the vascular suture was strengthened with a Teflon strip. During circulatory arrest, the aortic arch was crossed between the orifice of the left common carotid artery and left subclavian artery, with the cut extended to the isthmus region along the small curvature of the arch. The brachiocephalic trunk was aligned and brought down, with subsequent implantation into the ascending aorta prosthesis 2 cm below the initial fixation point. In the final stage, the kinked section of the left common carotid artery was resected and the aligned left carotid artery was directly reimplanted into the left subclavian artery using end-to-side anastomosis. The patient developed tracheobronchitis and moderate heart failure during the postoperative period. The duration of mechanical ventilation was 16 hours. Infusion and antibacterial therapy were discontinued on postoperative day 8. On postoperative day 13, the patient was discharged and referred to the outpatient centre for further treatment and rehabilitation. A sufficiently large-sized prosthesis allows for further development in paediatric patients. This is facilitated by the preservation of the native aortic root with restored valve function and the formation of a bevelled distal anastomosis with a small unchanged aortic section in the isthmus region, which maintains growth potential. This first reported case of an infant demonstrates the possibility of combination interventions on the aortic arch and brachiocephalic artery during the first year of life.Received 30 January 2021. Revised 24 March 2021. Accepted 29 March 2021.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflicts of interests.Contribution of the authors: The authors contributed equally to this article.

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Morphometry of the aortic arch and its branches

ARS Medica Tomitana ◽

10.2478/arsm-2013-0027 ◽

2013 ◽

Vol 19 (3) ◽

pp. 154-159 ◽

Cited By ~ 1

Author(s):

A.M. Manole ◽

D.M. Iliescu ◽

A. Rusali ◽

P. Bordei

Keyword(s):

Carotid Artery ◽

Aortic Arch ◽

Subclavian Artery ◽

Common Carotid Artery ◽

Left Subclavian Artery ◽

Ascending Aorta ◽

Ct Scanner ◽

Arterial Trunk ◽

Brachiocephalic Trunk ◽

The Right

Abstract Our study was conducted by the evaluation of angioCT’s performed on a GE LightSpeed VCT64 Slice CT Scanner. The measurements were performed on the aortic arch at the following levels: at the origin of the aorta, the middle part of the ascending aorta, prior to the origin of the brachiocephalic arterial trunk and after the origin of the left subclavian artery. We measured the caliber of the aortic arch arteries and the data are correlated and reported by gender. The diameter of the ascending aorta was between 27 to 28.9 mm in females and in males from 25.8 to 37.6 mm. The diameter of the aorta within the middle segment of the ascending part was between 28-30.2 mm in females and in males from 26.1 to 34.6. The diameter of the aortic arch prior to the origin of the brachiocephalic arterial trunk was between 26.4 to 29.4 mm in females and in males from 25.8 to 37.5 mm. The diameter of the aortic arch after the origin of the left subclavian artery was in a range of 20.4 to 28.4 mm, which corresponds to the limits found in males while in females the aortic diameter was between 21.3 to 24.1 mm. The brachiocephalic trunk diameters were 8.3 to 15.5 mm in females and in males was 9.1 to 14.5 mm. The right common carotid artery had a diameter of 4-8 mm diameter in males and in females ranged from 4.7 to 5.5 mm. The right subclavian artery showed a caliber of 5.7 to 7.5 mm in females and in males from 5.9 to 10.1. The left common carotid artery diameter was 4.6 to 5.7 mm in females and males the diameter was between 5.2 to 7.4 mm. The left subclavian artery had a diameter of 6-10 mm in females and in males ranged from 7.7 to 12.8 mm. We found that the distance between the ascending part of the aorta and the descending segment ranged from 33.3 to 38.5 mm in females and in males from 40 to 68.6 mm. We measured the distance that exists at the crossing of the aortic arch with the left branch of the pulmonary trunk, finding that in females this distance is 3 to 10.3 mm and in males from 3 to 12.5 mm.

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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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An unusual origin of the right subclavian artery – arteria lusoria

Current Issues in Pharmacy and Medical Sciences ◽

10.1515/cipms-2015-0022 ◽

2014 ◽

Vol 27 (4) ◽

pp. 234-236

Author(s):

Agnieszka Mocarska ◽

Miroslaw Szylejko ◽

Elzbieta Staroslawska ◽

Franciszek Burdan

Keyword(s):

Carotid Artery ◽

Aortic Arch ◽

Subclavian Artery ◽

Common Carotid Artery ◽

Left Common Carotid Artery ◽

Left Vertebral Artery ◽

Anatomical Anomaly ◽

Arteria Lusoria ◽

Brachiocephalic Trunk ◽

The Right

Abstract The aortic arch usually gives off three major arterial branches: the brachiocephalic trunk, the left common carotid artery and the left subclavian artery. The most frequently occurring developmental variations of arterial trunks origins are a joined brachiocephalic and left common carotid artery origin, the left vertebral artery branching from the aortic arch, a double aortic arch, and a change of sequence of branching arteries. The current report presents the rare asymptomatic situation of the right subclavian artery originating as the last individual branching from the aortic arch. This abnormality was accidentally discovered in a computed tomography examination of a 69-year old male patient. The examination showed that the artery went towards the neck posteriorly from the trachea. The anatomical anomaly was interpreted as being an arteria lusoria.

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Endo and exo aortic morphometry (endoluminal) in the aortic arch and its branches

ARS Medica Tomitana ◽

10.1515/arsm-2016-0018 ◽

2016 ◽

Vol 22 (2) ◽

pp. 103-107

Author(s):

S. Malik ◽

R. Baz ◽

C. Dina ◽

P. Bordei ◽

A. Rusali ◽

...

Keyword(s):

Carotid Artery ◽

Aortic Arch ◽

Thoracic Aorta ◽

Subclavian Artery ◽

Common Carotid Artery ◽

Left Subclavian Artery ◽

Average Diameter ◽

Left Common Carotid Artery ◽

Arterial Trunk ◽

Horizontal Diameter

Abstract Our study was conducted by the examination of angioCT’s, performing external measurements of aortic arch and the exo and endoaortic measurements of its three. The diameter of the thoracic aorta prior to the origin of the brachiocephalic arterial trunk was found with an average of 31.65 mm and below the left subclavian artery origin we found an average diameter of 24.3 mm. The brachiocephalic arterial trunk had an average diameter of 11.575 mm, 6.05 at carotid artery level and 9.05 mm at the level of the left subclavian artery. The endoaortic average diameter of the brachiocephalic arterial trunk: horizontally, 13.0 mm and vertically 11.7 mm; left common carotid artery horizontal diameter was 10.5 mm and 9.7 mm vertically and the left subclavian artery have 14.1 mm horizontally and 10.8 mm vertically.

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The arteries originating from the aortic arch and the branches of these arteries in red squirrels (Sciurus vulgaris)

Veterinární Medicína ◽

10.17221/3158-vetmed ◽

2011 ◽

Vol 56 (No. 3) ◽

pp. 131-134 ◽

Cited By ~ 1

Author(s):

A. Aydin

Keyword(s):

Carotid Artery ◽

Aortic Arch ◽

Subclavian Artery ◽

Common Carotid Artery ◽

Left Subclavian Artery ◽

Axillary Artery ◽

Thoracic Cavity ◽

Sciurus Vulgaris ◽

Brachiocephalic Trunk ◽

The Right

This study had the aim of investigating the anatomy of the aortic arch in squirrels (Sciurus vulgaris). Ten squirrels were studied. The materials were carefully dissected and the arterial patterns of arteries originating from the aortic arch were examined. The brachiocephalic trunk and the left subclavian artery were detached from the aortic arch. The brachiocephalic trunk first gave the left common carotid artery, and then detached to the right subclavian and common carotid artery. In all the examined materials, the left and right subclavian arteries gave branches that were similar after leaving the thoracic cavity from the cranial thoracic entrance. But while the whole branches of the the right subclavian artery were arising from almost the same point the left subclavian artery gave these branches in a definite order, and the branches that separated were the following: the internal thoracic artery, the intercostal suprema artery, the ramus spinalis, the vertebral artery and the descending scapular artery. It also gave the common branch formed by the junction of three of the cervical superficial, the cevical profund and the suprascapular arteries. After the separation of these branches, continuation of the artery gave the external thoracic artery on the external face of the thoracic cavity and then formed the axillar artery. The axillary artery separated into the subscapular and the brachial arteries. Thus, the arteries originating from the aortic arch and the branches of these arteries are different from other rodents and from domestic mammals.

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Isolation of Left Common Carotid Artery with Its Origin Proximal to Patent Ductus Arteriosus Presenting in Adult Age

Case Reports in Radiology ◽

10.1155/2016/4149365 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Anagha R. Joshi ◽

Saurabh Joshi ◽

Kiran Kale ◽

Rahul Jain ◽

Jernail Singh Bava

Keyword(s):

Carotid Artery ◽

Aortic Arch ◽

Subclavian Artery ◽

Common Carotid Artery ◽

Left Subclavian Artery ◽

Ductus Arteriosus ◽

Clinical Importance ◽

Left Common Carotid Artery ◽

Adult Age ◽

Ct Brain

Anomalies of aortic arch are a common occurrence. Such anomalies of right sided aortic arch with its various branching patterns are of clinical importance. Rarer anomalies include isolation (deficient connection) of either left subclavian artery or left common carotid artery; that is, they do not have their origin from aorta or its major branches. We present a case of an 18-year-old male who presented with gradual onset pulsatile swelling with bruit in neck on left side and was evaluated by CT brain and neck angiography. CT angiography revealed right sided aortic arch with aberrant left subclavian artery and isolated left common carotid artery. Very few cases of such an anomaly have been documented in the literature but none in an adult.

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Fenestrated TEVAR Using a Guidewire Fixator for Anchoring in Aortic Arch Target Vessels

Journal of Endovascular Therapy ◽

10.1177/1526602817744344 ◽

2017 ◽

Vol 25 (1) ◽

pp. 40-46 ◽

Cited By ~ 2

Author(s):

Tilo Kölbel ◽

Linus Bosaeus ◽

Nikolaos Tsilimparis ◽

Franziska Heidemann ◽

Fiona Rohlffs ◽

...

Keyword(s):

Carotid Artery ◽

Aortic Arch ◽

Stent Graft ◽

Subclavian Artery ◽

Endovascular Repair ◽

Common Carotid Artery ◽

Left Subclavian Artery ◽

Left Common Carotid Artery ◽

Target Vessel ◽

Arch Aneurysm

Purpose: To report a new facilitated method for securing target vessel access during single fenestrated and branched thoracic endovascular repair using a guidewire fixator. Technique: The Liungman Guidewire Fixator (LGF) includes a 0.035-inch guidewire that is fitted with a stopper close to the distal end and a self-expanding anchoring element that is freely movable over the guidewire to the point of the stopper. The technique of using a LGF for anchoring in a target vessel is described in a 75-year-old woman with a 53-mm saccular arch aneurysm. She was treated with a fenestrated Zenith stent-graft that had a catheter-preloaded fenestration for the left subclavian artery (LSA) and a scallop for the left common carotid artery. To avoid through-and-through wire and brachial access, the LGF was used to secure the guidewire in the LSA during stent-graft deployment. Conclusion: The use of an LGF for anchoring in the target LSA during fenestrated arch endografting was feasible and safe.

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Surgical bypass from the left common carotid artery to the left subclavian artery: Central approach

10.1510/mmcts.2021.023 ◽

2021 ◽

Keyword(s):

Carotid Artery ◽

Subclavian Artery ◽

Common Carotid Artery ◽

Left Subclavian Artery ◽

Thoracic Endovascular Aortic Repair ◽

Left Common Carotid Artery ◽

Aortic Diseases ◽

Landing Zone ◽

Surgical Bypass ◽

Aneurysm Dissection

To create an optimal landing zone (zone 2) in the aortic arch for concomitant or subsequent thoracic endovascular aortic repair of aortic diseases (aneurysm, dissection), surgeons frequently need to debranch the supra-aortic vessels. We present a surgical debranching of the left subclavian artery by performing a centrally located bypass from the left common carotid artery to the left subclavian artery.

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