Abstract
Objectives: The aim of this study was to present our experience with the management of isolated left vertebral artery (ILVA) during complex thoracic aortic pathology treated with the hybrid thoracic endovascular aortic repair.Methods: This is a single-center, respective cohort study. Between June 2016 and June 2020, 13 patients (12 men; median age 60 years old, range 42–72 years old) who underwent hybrid procedures were identified with ILVA in our center. Demographics, imaging features, operation details, and follow-up in these patients were collected and analyzed.Results: In this study, all patients received the hybrid procedure, and the primary technical success rate was 100%. There were no in-hospital deaths. Complication occurred in two (15.4%) patients. One patient suffered from contrast-induced acute kidney injury (CI-AKI) and recovered before discharge. Another patient required reintervention for acute left-lower-limb ischemia, which was successfully treated using Fogarty catheter embolectomy. Immediate vagus/recurrent laryngeal never palsy, lymphocele, and chylothorax were not observed. The median duration of follow-up was 22 months (range, 13–29 months). No neurologic deficits, bypass occlusion, or ILVA occlusion or stenosis were observed during the follow-up. No aortic rupture, cerebrovascular accident, or spinal cord ischemia was observed during the follow-up period.Conclusions: Our limited experience reveals that hybrid procedures [thoracic endovascular aortic repair (TEVAR), ILVA transposition, and left common carotid artery-left subclavian artery (LCCA-LSA) bypass] are relatively safe, feasible, and durable for the treatment of thoracic aortic pathology with ILVA. However, further technique durability and larger studies with long-term follow-up periods are warranted.
Highlights
Supra-aortic trunk (SAT) variation was common in the vertebral artery (VA)
We routinely evaluated aortic arch characteristics, the geometry of SAT and carotid vessels, and integrity of Willis circle and both the vertebral arteries by digital subtraction angiography (DSA) before surgical procedure to exclude certain concomitant diseases or variants, which were undiscovered by computed tomography angiography (CTA)
Five (38.5%) cases of isolated left vertebral artery (ILVA) entered the circle of Willis to form the basilar artery, and eight (61.5%) cases of ILVA terminated at the posterior–inferior cerebellar artery (PICA)
Summary
Isolated left vertebral artery (ILVA) has arisen directly from the aortic arch, usually between the left common carotid artery (LCCA) and the left subclavian artery (LSA), and it was the second most common anatomical variation of the SAT [1]. The prevalence of this variation was 0.8–6.6% in patients with the thoracic aortic disease according to clinical studies [2,3,4,5]. Coverage and revascularization of the LSA in type B aortic dissection (TBAD) patients with ILVA had been reported by previous case reports [6, 7, 10]. Because the cases were rare, there were no widely adopted strategies regarding the reconstruction of ILVA
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