Transposition of the left vertebral artery during endovascular stent-graft repair of the aortic arch

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

“…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…”

Commentary: How to transpose the isolated left vertebral artery in hybrid thoracic endovascular aortic repair

“…In this issue of The Journal of Thoracic and Cardiovascular Surgery, Piffaretti and colleagues 1 presented their experience of managing the isolated left vertebral artery (ILVA) during hybrid aortic arch repair with thoracic endovascular aortic repair (TEVAR) completion. The ILVA arises directly from the aortic arch, usually between the left common carotid artery and the left subclavian artery, and it is the second most common anatomic variant of the supra-aortic configuration.…”

Commentary: Dealer's choice!

“…The isolated left vertebral artery (ILVA) has its origin directly off the aorta, and is the second most common (after bovine arch) aortic arch variant, occurring in 2% to 4% of patients. 1,2 In their article in this issue of the Journal, ''Transposition of the Left Vertebral Artery During Endovascular Stent-Graft Repair of the Aortic Arch,'' Piffaretti and colleagues 3 report their experience with transposition of the ILVA during stent-graft repair of the aortic arch and descending thoracic aorta. They achieved successful outcomes without neurologic sequelae in all cases.…”

“…In the experience of Piffaretti and colleagues, 3 ILVA transposition was a rarely employed procedure as they noted an ILVA in 9 of 279 patients from 2007 to 2018. Only 6 of these 9 patients required transposition, because in 1 case the ILVA was occluded, 1 patient needed repair of a saccular aneurysm off the inferior transverse arch, and 1 patient required a descending thoracic stent without LSA coverage.…”

“…Except for specific clinical scenarios, the decision for ILVA and LVA revascularization still appears to be dealer's choice! Postscript: The invitation to comment on the article of Piffaretti and colleagues 3 afforded an opportunity to review the clinical expertise of Dr Ramon Berguer, former Chairman of Vascular Surgery at Wayne State University, who published one of the earliest and largest series of vertebral artery reconstructions. 7…”