Thoracic Endovascular Aortic Repair for Aberrant Subclavian Artery and Stanford Type B Aortic Intramural Hematoma.

Xia Xu,Ningxin Hou,Daoquan Wang,Jun Li,Hongmin Zhou,Liang Tian

doi:10.3389/fsurg.2021.813970

Abstract

ObjectivesTo evaluate the in-hospital and later outcomes of thoracic endovascular aortic repair (TEVAR) for type B intramural hematoma (TBIMH) combined with an aberrant subclavian artery (aSCA).MethodsIn the period from January 2014 to December 2020, 12 patients diagnosed with TBIMH combined with aSCA and treated by TEVAR were enrolled in this retrospective cohort study, including 11 patients with the aberrant right subclavian artery (ARSA) and 1 with an aberrant left subclavian artery (ALSA). A handmade fenestrated stent-graft or chimney stent or hybrid repair was performed when the proximal landing zone was not enough.ResultsThe mean age of all the patients was 59.2 ± 7.6 years, and 66.7% of patients were men. There were 4 patients with Kommerell's diverticulum (KD). The procedures in all 12 patients were technically successful. There was one case each of postoperative delirium, renal impairment, and type IV endoleak after TEVAR. During follow-up, 1 patient died of acute pancreatitis 7 months after TEVAR. The overall survival at 1, 3, and 5 years for the patients was 90.9, 90.9, and 90.9%, respectively. KD was excluded in 2 patients, and the handmade fenestrated stent-graft was applied in the other 2 patients to preserve the blood flow of the aSCA. No neurological complications developed and no progression of KD was observed during the follow-up.ConclusionThoracic endovascular aortic repair for patients with aSCA and TBIMH is promising. When KD was combined, we could exclude KD or preserve the blood flow of aSCA with regular follow-up for the diverticulum according to the size of the KD.

Highlights

Aberrant subclavian artery is a common congenital anomaly of the aortic arch with two typical subtypes: left-sided aortic arch with an aberrant right subclavian artery (ARSA) and rightsided aortic arch with an aberrant left subclavian artery (ALSA) [1]
Acute aortic syndromes comprise a constellation of lethal medical entities, such as acute aortic dissection (AD), aortic intramural hematoma (IMH), and penetrating atherosclerotic ulcer (PAU) [6]
Lesions that do not involve the ascending aorta are classified as Stanford type B, of which most can be treated by thoracic endovascular aortic repair (TEVAR) with less trauma and fewer complications [6]

Summary

Introduction

Aberrant subclavian artery (aSCA) is a common congenital anomaly of the aortic arch with two typical subtypes: left-sided aortic arch with an aberrant right subclavian artery (ARSA) and rightsided aortic arch with an aberrant left subclavian artery (ALSA) [1]. ARSA is relatively common, with an incidence of 0.5–1.8%, while ALSA is less common, with an incidence of 0.05% [2]. It is reported about 20–60% of patients with aSCA have an associated Kommerell’s diverticulum (KD), TEVAR for aSCA and TBIMH an aneurysmal aortic dilatation at the origin of the aSCA, which rarely causes dysphagia or dyspnea but may progress to aortic dissection (AD) or rupture [3, 4]. Lesions that do not involve the ascending aorta are classified as Stanford type B, of which most can be treated by thoracic endovascular aortic repair (TEVAR) with less trauma and fewer complications [6]. When combined with type B acute aortic syndromes, the aSCA may affect the proximal landing zone (PLZ) of the stent and limit the application of TEVAR

Objectives

Methods

Results

Discussion

Conclusion