Left Subclavian Artery Management in Endovascular Repair of Thoracic Aortic Aneurysms and Aortic Dissections

Tiesenhausen, Kurt; Hausegger, K. A.; Oberwalder, Peter; Mahla, Elisabeth; Tomka, M.; Allmayer, T.; Baumann, A.; Hessinger, M.

doi:10.1046/j.1540-8191.2003.02078.x

Cited by 77 publications

(83 citation statements)

References 19 publications

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“…However, some patients do require additional transposition or bypass of the LSA to the LCCA (ie, those having undergone coronary artery bypass grafting with patent left internal mammary arteries, and those presenting with carotid or vertebral artery stenoses or anatomical variants of the subclavian, vertebral, or basilar arteries, or the circle of Willis [1, 8]). Another indication for transposing the LSA or for LCCA to LSA bypass surgery with proximal ligation is to prevent type II endoleaks with retrograde perfusion of the aneurysm sac or the false lumen in dissections [2]. In our previous investigation, we covered the LSA with ESGs without ligating the LSA, observing no type II endoleaks from the LSA during follow-up [4].…”

Section: Commentmentioning

confidence: 96%

“…In that case, it may be necessary to cover the origin of the supra-aortic vessels using endovascular stent grafts (ESGs) to extend the proximal landing zone. Without revascularization of the supra-aortic branches, a range of neurologic and vascular complications may ensue [2,3]. Surgical aortic arch de-branching is therefore indicated before covering the brachiocephalic trunk (BT) and left common carotid artery (LCCA) by ESGs.…”

Section: Endovascular Aortic Arch Repair (Evaar) Is Less Invasivementioning

confidence: 99%

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Endovascular Aortic Arch Repair After Aortic Arch De-branching

Weigang

Parker

Czerny

et al. 2009

The Annals of Thoracic Surgery

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Purpose. Conventional surgical therapy of aortic arch aneurysms consists of aortic arch replacement requiring cardiopulmonary bypass and deep hypothermic circulatory arrest. This method is associated with significant morbidity and mortality, mainly due to neurologic complications and the sequelae of deep hypothermic circulatory arrest. Thus, it makes sense to work on developing less invasive surgical techniques.Description. Surgical aortic arch de-branching is required before the supra-aortic vessels can be safely covered by an endovascular stent graft. We describe how the supra-aortic vessels can best be revascularized, followed by complete coverage of the aortic arch with endovascular stent grafts.Evaluation. We hereby present our case selection criteria, preoperative work-up, and surgical approach for aortic arch de-branching with supra-aortic revascularization, followed by complete coverage of the aortic arch by endovascular stent grafting. This technique's safeguards and pitfalls are described for a cohort of 26 patients. We now describe how the BT and LCCA can best be revascularized, followed by complete coverage of the aortic arch with ESGs. Conclusions. Endovascular aortic arch repair after aortic arch de-branching has Technique PatientsWe performed EVAAR after aortic arch de-branching in 26 patients. We chose the endovascular approach over conventional aortic arch replacement with cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest in selected patients considered at high-risk due to multiple comorbidities and advanced age (Fig 1). Aortic arch pathology consisted of an aneurysm in 15 cases, and 6 patients presented a previous aortic dissection with development of an aortic arch aneurysm. A penetrating ulcer in the aortic arch was the underlying pathology in five cases. The ethics committees approved the study and waived the need for patient consent. Arch Vessel RevascularizationSurgery was initiated with an upper right, L-shaped, hemi-sternotomy to the third or fourth intercostal space. After exposing the ascending aorta, the supraaortic vessels were dissected and the innominate vein was encircled. Then the ascending aorta was tangen-

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Section: Commentmentioning

confidence: 96%

Section: Endovascular Aortic Arch Repair (Evaar) Is Less Invasivementioning

confidence: 99%

Endovascular Aortic Arch Repair After Aortic Arch De-branching

Weigang

Parker

Czerny

et al. 2009

The Annals of Thoracic Surgery

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show abstract

“…Gelişebilecek subklavian arter rüp-türü yaşamı tehlikeye sokacak kanamalara neden olabilir. Üst ekstremite renk değişikliği, ısı kaybı, duyu kaybı ve radial nabızların alınmaması tipik fizik muayene bulgularıdır (11). Penetran yaralanma, özelliklede ateşli silah yaralanması sonrası gelişebilecek subklavian arter anevrizmaları ise diğer etiyolojik nedenlere göre çok daha azdır.…”

Section: şEkil 1: İlk Kontraslı Bilgisayarlı Toraks Tomografisi (üç Bunclassified

INTERACTIVE CASE REPORT: Left Subclavian Artery Aneurysm after Gunshot Injury

Çakmak¹,

Durkan²,

Öztürk³

et al. 2016

Respir Case Rep

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“…The main problem is ensuring sufficient length of the proximal anchoring zone. To address this problem, either a technique that covers the branching of the left subclavian artery (LSA) is used or the endovascular approach is combined with surgical resewing of the branches of the supra-aortic arteries (hybrid aortic repair) [11,12].…”

Section: Introductionmentioning

confidence: 99%