Thoracic endovascular aortic repair in penetrating aortic ulcer combined with isolated left vertebral artery

Abstract

Rationale:Penetrating aorta ulcer (PAU) with isolated left vertebral artery (ILVA) is a rare condition, accounting for no more than 1% of all kinds of aorta diseases. And traditional treatment was open surgery with total arch replacement by elephant trunk. Here, we report a case of PAU combined with ILVA managed by thoracic endovascular aortic repair (TEVAR) technique.Patient concerns:A 65-year-old male with chronic hypertension and Nicotine abuse underwent intermittent back pain for 2 years and aggravated a bit for 1 week.Diagnoses:Preoperative computed tomography angiogram (CTA) indicated PAU combined with ILVA.Interventions:TEVAR was performed for PAU following with retrograde in situ fenestration and chimney technique for revascularization of ILVA and left subclavian artery (LSA), respectively.Outcomes:The operation was successfully and the patient was discharged from hospital after 1 week of treatment. Postoperatively, the images of CTA illustrated the patency of aorta, ILVA, and LSA without obvious endoleak. Besides, no ischemia attack or other relative syndromes were detected at 6-months follow-up.Lessons:This case demonstrates that TEVAR is an alternative to elephant trunk especially for PAU with ILVA. And it also showed the precise exposure of ILVA and necessity to reconstruct ILVA during TEVAR operation in order to reduce the occurrence of ischemia attack.

Hybrid surgery of vertebral artery transposition combined with scallop and fenestration technique for the repair of type B aortic dissection patient with isolated left vertebral artery: A case report

“…A previous study reported successful treatment of penetrating aorta ulcer with an isolated left vertebral artery through in situ fenestration and chimney technique for revascularization of isolated left vertebral artery and the LSA. [ 14 ] In order to obtain sufficient anchoring area, we created a scallop at the beginning of the coated stent to extend it to the middle of the left common carotid artery. Additionally, we used the in situ fenestration technique to reconstruct the LSA and transposed the left vertebral artery to the left carotid artery to avoid stent coverage in this patient with AD.…”

Physician-modified fenestration or in situ fenestration for preservation of isolated left vertebral artery in thoracic endovascular aortic repair

“…The presence of an ILVA has significant impact on the choice of aortic arch reconstruction techniques and cerebral protection methods ( 18 ). Current literature reported several options such as total open surgery ( 18 ), hybrid procedure ( 9 , 19 ) and parallel stents technique ( 20 ) to deal with aortic arch lesions and ILVAs. However, there was no consensus on the indication and strategy for ILVA reconstruction to date, as the relevant studies were scarce.…”

“…Parallel grafts such as the chimney technique has been used for preservation of ILVA, implying a feasible alternative with encouraging short-term results ( 20 ). However, the risk of type Ia endoleaks through the gutters and uncertainty regarding the long-term patency of artery remain a concern ( 26 ).…”

One-stage supraclavicular hybrid procedure for type B aortic dissection involving three rare anatomical anomalies: a case report and literature review

“…We reviewed previous cases with one or more anomalies (Table 1). 2,7–20 Nonami et al. 7 reported that a patient with ARSA and ILVA with aortic aneurysm successfully underwent aortic arch replacement with five branches, in 1998.…”

“…However, traditional TEVAR is unsuitable for all patients because of landing zone limitations. Other surgeons have reported aortic dissection or aneurysm with ARSA or ILVA occurring alone, treated with total endovascular repair, 9–12 hybrid procedure, 12–17 or open surgery. 18–20…”