implantation of left vertebral artery onto the left carotid artery was not possible due to the unusually short cervical portion of the pre-foraminal VA due to its early entry into foramen transversarium of C7 instead of C6. It was therefore decided to proceed with left carotid to left vertebral artery and left carotico-subclavian artery bypass prior to TEVAR of the descending aorta. Methods-Using a transverse left cervical approach the left VA was dissected out as it ascended towards the foramen transversarium of C7. Using the great saphenous vein an interposition graft was raised between the left common carotid and left VA using 7/0 prolene. Intraoperative Doppler assessment confirmed satisfactory flow. An ipsilateral carotico-subclavian bypass was then performed with Dacron graft using 6/0 prolene. TEVAR was then performed with a 26 mm x100 mm C-Tag Ò stent. Results-CT angiography on the 2nd postoperative day confirmed patency of both carotico-vertebral and caroticosubclavian grafts and satisfactory placement of the TEVAR stent. The patient was noted to have a left Horner's syndrome but otherwise made an uneventful recovery. He was discharged on the 3rd postoperative day. At follow up one month later he remained well with no complications and complete resolution of Horner's syndrome. Conclusion-Patients with traumatic Aortic tears undergoing emergency TEVAR and in whom a proximal landing zone will seal the origin of an aberrant dominant left vertebral artery arising from aortic arch (proximal or distal to the LSA) should have vertebral artery revascularization prior to deployment of the TEVAR. References P-001 Near Infrared Spectroscopy and Toe Flexion in the Dynamic Assessment of Diabetic Foot Perfusion
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