Great Vessel Disease

2015 ◽  
Author(s):  
Thomas C. Bower ◽  
Kenneth J. Cherry Jr
Keyword(s):  
Carotid Artery ◽  
Aortic Arch ◽  
Bypass Graft ◽  
Graft Infection ◽  
Artery Aneurysm ◽  
Occlusive Disease ◽  
Aortic Aneurysms ◽  
Hybrid Technique ◽  
Elephant Trunk ◽  
Hybrid Techniques

The great vessels or supra-aortic trunks (SATs) are most often affected by occlusive disease. Aneurysms of the SATs are much rarer compared with other vascular territories and may be associated with aneurysms or dissections of the ascending aorta and arch or aneurysms in other locations. Treatment of SAT aneurysms has evolved from ligation or exclusion to aneurysm resection with autogenous or prosthetic interposition grafts. There is now a growing body of literature describing the use of endovascular techniques to treat occlusive disease or SAT aneurysms. Hybrid techniques, which combine SAT revascularization by direct or cervical routes with aortic stenting, have also grown in popularity. This review covers anatomy, etiology and aortic arch pathology, clinical presentation, diagnosis, indications for treatment, open reconstruction for occlusive lesions, extrathoracic arterial reconstruction, aortic arch repair, endovascular treatment, and prosthetic SAT graft infection or involvement by tumor. Tables outline distribution of atherosclerotic lesions and extended carotid artery aneurysm studies from 2005 to 2012. Figures show a small subclavian artery aneurysm, thromboembolic occlusion of the brachial and forearm arteries, and digital infarcts; sternal exposure; multivessel supra-aortic trunk reconstruction; a subclavian to carotid artery transposition; three-dimensional relationships of a retropharyngeal and an anteriorly tunneled carotid-carotid bypass; an ascending aortic and total arch repair using an elephant trunk; distal arch and descending thoracic aortic aneurysms with chronic dissection treated with a hybrid technique; complex redo aortic coarctation and SAT reconstruction; hybrid repair of a developmental aortic arch abnormality, a large aberrant right subclavian aneurysm, and Kommerell diverticulum; infection of an ascending aortobilateral distal carotid prosthetic bypass graft originally placed for Takayasu arteritis; and an angiosarcoma involving the innominate, right subclavian, and cervical common carotid arteries and the internal jugular vein. This review contains 11 figures, 2 tables, and 81 references.

Transradial Access or Simmons Shaped 8F Guide Enables Delivery of Flow Diverters in Patients With Large Intracranial Aneurysms and Type III Aortic Arch: Technical Case Report

2012 ◽  
Vol 73 (suppl_1) ◽  
pp. onsE111-onse116 ◽  
Author(s):  
Carolin Dietrich ◽  
Gesa H. Hauck ◽  
Luca Valvassori ◽  
Erik F. Hauck
Keyword(s):  
Carotid Artery ◽  
Aortic Arch ◽  
Intracranial Aneurysms ◽  
Artery Aneurysm ◽  
Acute Onset ◽  
Third Nerve Palsy ◽  
Type Iii ◽  
Complex Aneurysms ◽  
Transradial Access ◽  
Internal Carotid Artery Aneurysm

Abstract BACKGROUND AND IMPORTANCE: Flow diversion with the pipeline embolization device (PED) is an emerging endovascular technology allowing curative embolization of very large and giant intracranial aneurysms. Many patients with these complex aneurysms are older. The presence of a tortuous type III aortic arch reduces the chances of successful PED delivery and increases the risk of complications. We report 2 technical nuances regarding the delivery of the PED in older patients with a complex aortic arch. CLINICAL PRESENTATION: In case 1, an 87-year-old woman presented with acute-onset left third nerve palsy. Workup demonstrated an 18-mm left posterior carotid wall aneurysm with a large daughter aneurysm on its dome. Endovascular access was complicated by a type III aortic arch with a hyperacute angle at the origin of the left common carotid artery. An 8F Simmons II shaped guide formed a stable platform, allowing successful PED delivery. In case 2, a 76-year-old woman experienced a transient ischemic attack. She harbored a right-sided 20-mm cavernous internal carotid artery aneurysm. She was treated with 2 PEDs deployed via a transradial approach. CONCLUSION: Transradial access or guide support with the 8F Simmons II catheter grants stable access for curative embolization with the PED in elderly patients with a large intracranial aneurysm and a complex aortic arch.

scholarly journals Reversed Frozen Elephant Trunk Technique to Treat a Type II Thoracoabdominal Aortic Aneurysm

2016 ◽  
Vol 24 (2) ◽  
pp. 277-280 ◽  
Author(s):  
E. Sebastian Debus ◽  
Tilo Kölbel ◽  
Sabine Wipper ◽  
Holger Diener ◽  
Beate Reiter ◽  
...  
Keyword(s):  
Stent Graft ◽  
Spinal Cord Ischemia ◽  
False Lumen ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Aortic Aneurysms ◽  
Hybrid Technique ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Elephant Trunk Technique ◽  
Frozen Elephant Trunk Technique

Purpose: To describe a hybrid technique of reversed frozen elephant trunk to treat thoracoabdominal aortic aneurysms (TAAA) through an abdominal only approach. Technique: The technique is demonstrated in a 29-year-old Marfan patient with a chronic type B aortic dissection previously treated with a thoracic stent-graft who presented with a thoracoabdominal false lumen aneurysm. Through an open distal retroperitoneal approach to the abdominal aorta, a frozen elephant trunk graft was implanted over a super-stiff wire upside down with the stent-graft component in the thoracic aorta. Following deployment of the stent-graft proximally and preservation of renovisceral perfusion in a retrograde manner, the renovisceral vessels were sequentially anastomosed to the elephant trunk graft branches, thus reducing the ischemia time of the end organs. The aortic sac was then opened, and the distal part of the hybrid graft was anastomosed with a further bifurcated graft to the iliac vessels. Conclusion: The reversed frozen elephant trunk technique is feasible for hybrid treatment of TAAAs via an abdominal approach only. This has the benefit of substantially reducing the trauma of thoracic exposure, thus preserving major benefits of open thoracoabdominal surgery, such as the presence of short bypasses to the renovisceral vessels and reimplantation of lumbar arteries to reduce spinal cord ischemia.

Axillo-Axillary Artery Bypass With Coil Embolization of the Innominate Artery for a Traumatic Innominate Artery Aneurysm: A Case Report

2018 ◽  
Vol 52 (7) ◽  
pp. 573-578 ◽  
Author(s):  
Ryota Sugisawa ◽  
Masaki Sano ◽  
Naoto Yamamoto ◽  
Kazunori Inuzuka ◽  
Hiroki Tanaka ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Coil Embolization ◽  
Axillary Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Graft Infection ◽  
Artery Aneurysm ◽  
Innominate Artery ◽  
Neurological Deficits ◽  
Cervical Region

Background: Innominate artery aneurysm (IAA) is a rare cervical artery aneurysm. Although atherosclerosis is its most common cause, IAAs due to cervical injury are often reported. Operative indications for IAAs include rupture or symptomatic aneurysm, saccular aneurysm, aneurysm with a diameter of 3 cm or greater, and aneurysmal change of the origin of the innominate artery. Although the ligature of the innominate artery or open surgical repair is well described, the usefulness of endovascular repair has also recently been reported. Herein, we report a case of traumatic IAA with infection in the cervical region after tracheostomy. Case Presentation: A 40-year-old man with cholecystolithiasis planned to undergo laparoscopic cholecystectomy at another hospital. Urgent tracheostomy was performed because of laryngeal edema at the induction of general anesthesia. Enhanced computed tomography angiography 1 week after the tracheostomy revealed a saccular IAA. The patient was deemed to be at high risk for aneurysm rupture and was referred to our hospital. Preoperative Matas test, Allcock test, and innominate arterial stump pressure measurement were performed to assess the cerebral blood flow and ischemic tolerance of the brain. These examinations showed the patency of the circle of Willis. An axillo-axillary artery bypass with coil embolization of the innominate artery was performed to avoid postoperative vascular graft infection. No postoperative complications such as infection or cerebral infarction occurred. Magnetic resonance imaging angiography performed 6 months after surgical treatment showed that the aneurysm had disappeared, and patency of the bypass graft was present. There were no postoperative complications, such as neurological deficits or graft infection, at more than 5 years after surgery. Conclusions: We report a successfully treated case of IAA after tracheostomy. Axillo-axillary artery bypass with coil embolization of the innominate artery is an effective treatment of IAA with cervical infection.

Aortic Arch and Descending Thoracic Aortic Aneurysms: Experience with Stent Grafting for Second-Stage “Elephant Trunk” Repair

Vascular ◽  
2005 ◽  
Vol 13 (1) ◽  
pp. 5-10 ◽  
Author(s):  
Alfio Carroccio ◽  
David Spielvogel ◽  
Sharif H. Ellozy ◽  
Robert A. Lookstein ◽  
Iris Y. Chin ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Stent Graft ◽  
Clinical Success ◽  
Perioperative Complications ◽  
Aortic Aneurysms ◽  
Elephant Trunk ◽  
Stent Grafting ◽  
Thoracic Aortic Aneurysms ◽  
Second Stage ◽  
Antegrade Approach

Reconstruction of aortic arch and descending thoracic aortic aneurysms (TAAs) is technically challenging and associated with significant morbidity and mortality. We report our experience with extensive TAAs using a two-stage “elephant trunk” repair, with the second stage completed using an endovascular stent graft (ESG). Over 6 years, 111 patients underwent ESG treatment of TAAs at Mount Sinai Medical Center. Twelve of these patients were referred for ESG placement for the second stage of elephant trunk reconstruction because comorbidities placed them at high risk of open surgical repair. Our database was analyzed for technical and clinical success and perioperative complications. The mean follow-up was 11.8 months (range 1–64 months). Twelve patients (five women and seven men) with a mean age of 69 ± 10 years underwent repair of their distal aortic arch and descending TAAs. These aneurysms included nine atherosclerotic aneurysms, one pseudoaneurysm, and two penetrating atherosclerotic ulcers. Three patients were symptomatic. Stent graft repair was technically successful in 91.7% or 11 of 12 patients. Excessive aortic arch tortuosity resulted in failure to deploy a stent graft in one patient. An antegrade approach through the open elephant trunk was used in two patients with severe iliac occlusive disease. Endoleaks (type 2) were identified in two patients with no aneurysm expansion; however, a 14 mm expansion over 1 year occurred in a patient with no identifiable endoleak. One early mortality occurred in a patient with a ruptured 6 cm infrarenal AAA after successful exclusion of the 8 cm TAA. Second-stage elephant trunk reconstruction of an extensive TAA using an ESG is effective in the short term. Its long-term durability remains to be determined.

Aortic aneurysm: aortic arch aneurysm

ESC CardioMed ◽  
2018 ◽  
pp. 2575-2577
Author(s):  
Roberto Bartolomeo ◽  
Alessandro Leone ◽  
Luca Di Marco ◽  
Davide Pacini
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Arch ◽  
Distal Segment ◽  
Aortic Aneurysms ◽  
Elephant Trunk ◽  
Mortality And Morbidity ◽  
Medial Degeneration ◽  
Hybrid Prosthesis ◽  
Mycotic Aneurysms ◽  
Elephant Trunk Procedure

Thoracic aortic aneurysm (TAA) is defined as aneurysmal degeneration that occurs in the thoracic aorta. The incidence of TAA is increasing with improvements in screening, as well as advances in imaging. They are often asymptomatic but in some cases, they may compress the innominate vein or airway or they may stretch the left recurrent laryngeal nerve, causing hoarseness. TAA often results from cystic medial degeneration and when it occurs at younger ages, it is classically associated with connective tissue disorders, such as Marfan syndrome or, less commonly, Ehlers–Danlos syndrome and Loeys–Dietz syndrome. Mycotic aneurysms, once the predominant cause of ascending and arch aneurysms, are rare today. Diagnosis is often casual and can be suspected on the basis of chest X-ray or as for ascending aortic aneurysms, diagnosed by transthoracic echocardiogram. However, the computed tomography angiography scan represents the gold standard examination for diagnosis. The aortic arch operation consists of the replacement of the arch with reimplantation of the supra-aortic vessels. Effective methods of cerebral, myocardial, as well as visceral protection are necessary to obtain acceptable results in terms of hospital mortality and morbidity. The ‘elephant trunk’ procedure can be an alternative technique for total arch repair; however, a recent evolution of the ‘elephant trunk’ procedure is the ‘frozen elephant trunk’ technique. This technique consists of the implantation of the stented distal segment of the hybrid prosthesis into the descending aorta through the opened aortic arch, while the proximal, non-stented segment is used for conventional replacement of the aortic arch.

Republished: Separate origins of the left internal and external carotid arteries from the aortic arch and cervical internal carotid artery aneurysm in a patient with Noonan syndrome

2016 ◽  
Vol 9 (4) ◽  
pp. e11-e11 ◽  
Author(s):  
Rizwan Ahmad Tahir ◽  
Karam Asmaro ◽  
Aqueel Pabaney ◽  
Max Kole ◽  
Timothy Nypaver ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Aortic Arch ◽  
Noonan Syndrome ◽  
Internal Carotid ◽  
Anatomical Variation ◽  
Artery Aneurysm ◽  
External Carotid ◽  
Fetal Life ◽  
Internal Carotid Artery Aneurysm

Distinct origins of the external carotid artery and the internal carotid artery (ICA) from the aortic arch have been rarely described, and represent an aberrant development of the aortic arches during fetal life. This anatomical variation is usually discovered incidentally; infrequently, an aneurysm of the cervical ICA might accompany this rare configuration. We describe one such case in a patient with Noonan syndrome who presented with pulsatile neck mass. The diagnostic features and management of the aneurysm and a review of the literature are presented.

Insertion of a bypass graft from carotid artery to descending aorta in the management of aortic coarctation with severe hypoplasia of the aortic arch—a report of two cases

1993 ◽  
Vol 3 (1) ◽  
pp. 76-78
Author(s):  
Ganga Prabhakar ◽  
Naresh Kumar ◽  
Zohair Al Halees ◽  
Neil Wilson
Keyword(s):  
Surgical Technique ◽  
Carotid Artery ◽  
Aortic Arch ◽  
Aortic Coarctation ◽  
Bypass Graft ◽  
Descending Aorta ◽  
Residual Stenosis ◽  
Cardiac Abnormalities ◽  
Standard Procedures ◽  
The Individual

AbstractRepair of severe hypoplasia of the aortic arch with coarctation must be based on the individual anatomy of the lesion and, where necessary, one should take into consideration associated cardiac abnormalities. We report a surgical technique which was employed when standard procedures for reconstruction of the arch had failed to relieve the obstruction adequately. A conduit from the carotid artery to the descending aorta was used successfully in two patients to abolish residual stenosis.

scholarly journals Reoperative Aortic Arch Surgery under Mild Systemic Hypothermia: Two-Center Experience

Aorta ◽  
2021 ◽  
Author(s):  
Petar Risteski ◽  
Isabel Radacki ◽  
Andreas Zierer ◽  
Aris Lenos ◽  
Anton Moritz ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Cerebral Perfusion ◽  
Operative Mortality ◽  
Mild Hypothermia ◽  
Aortic Surgery ◽  
Graft Infection ◽  
Elephant Trunk ◽  
Aortic Arch Surgery ◽  
Systemic Hypothermia ◽  
Antegrade Cerebral Perfusion

Abstract Background The aim of the study was to assess the indications, surgical strategies, and outcomes after reoperative aortic arch surgery performed generally under mild hypothermia. Methods Ninety consecutive patients (60 males, mean age, 55 ± 16 years) underwent open reoperative aortic arch surgery after previous cardiac aortic surgery. The indications included chronic-progressive arch aneurysm (55.5%), chronic aortic dissection (17.8%), contained arch rupture (16.7%), and graft infection (10%). The reoperation was performed through a repeat sternotomy (96%) or clamshell thoracotomy (4%) using antegrade cerebral perfusion under mild systemic hypothermia (28.9 ± 2.5°C) in all except three patients. Results The surgery comprised hemiarch or total arch replacement in 41 (46%) and 49 (54%) patients, respectively. The distal extension included classic or frozen elephant trunk technique, each in 12 patients, and total descending aorta replacement in 4 patients. Operative mortality was 6 (6.7%) among all patients, with age identified as the only independent predictor of operative mortality (p = 0.05). Permanent and transient neurologic deficits occurred in 1% and 9% of the patients, respectively. Estimated survival at 8 years was 59 ± 8% with advanced heart failure predictive for late mortality (p = 0.014). Freedom from second reoperation or intervention on the aorta was 78 ± 6% at 8 years, with most of these events occurring downstream in patients with chronic degenerative aneurysms. Conclusion Aortic arch reoperations performed using antegrade cerebral perfusion under mild systemic hypothermia offer favorable operative outcomes with an exceptionally low rate of neurologic morbidity without any difference between hemiarch and complex arch procedures.

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