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Luo ZR, Zhu YP, Fang GH. Utilizing Single-Branched Stent in Combination With Fenestration or Chimney for Endovascular Repair of Aortic Arch Lesions With Aberrant Subclavian Artery. J Endovasc Ther 2024:15266028241259391. [PMID: 38887028 DOI: 10.1177/15266028241259391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
OBJECTIVE The study was to figure out the feasibility, efficacy, and safety of a single-branched stent graft, namely Castor, in combination with fenestration or chimney in the context of aortic arch lesions presenting with aberrant subclavian artery (ASA) and/or Kommerell's diverticulum (KD). METHODS All consecutive patients with aortic arch lesions and ASA and/or KD receiving Castor from June 2018 to June 2023 were investigated. RESULTS Incorporating 18 patients, the study encompassed 11 cases with KD, 3 cases with dysphagia; 2 cases of right-sided aortic arch with left-sided aberrant left subclavian artery (ALSA), and 16 cases of left-sided aortic arch with right-sided aberrant right subclavian artery (ARSA). The mean operation time was 132±23 minutes. The mean measured proximal aortic diameter was 30.9±1.6 mm, and proximal diameter of Castor stent was 34 (32, 34.5) mm, with oversize of 9.1±1.6%; the mean measured branch diameter was 8.8±0.97 mm, and branch diameter of Castor stent was 10 (8, 10) mm, with oversize of 0.86±0.57 mm. Technical success rate was 100%, and no in-hospital mortality, no stroke, and no endoleak were identified. One (5.6%) case with spinal cord ischemia and one (5.6%) case with poor healing of operative site were identified. During the follow-up period, no aortic-related death or secondary intervention was recorded. The maximal aortic diameter was significantly reduced at the sixth postoperative month (padj=0.031); KD diameter was significantly reduced at the third (padj=0.001) and sixth (padj<0.001) postoperative month. CONCLUSION Totally endovascular repair of aortic arch lesions with ASA and KD via Castor stent in combination with fenestration or chimney is feasible, effective, and safe, which can achieve an encouraging medium-term outcome and provide excellent remodeling at the lesions. CLINICAL IMPACT Single branched stent in combination with fenestration or chimney achieved a sufficient proximal landing zone and provided an encouraging medium-term outcome in this retrospective review of 18 patients receiving endovascular treatment of pathological aortic arch with aberrant subclavian artery and/or Kommerell's diverticulum. The authors suggest this time-saving and efficient technique to establish systematic experience for the treatment in this kind of patients.
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Affiliation(s)
- Zeng-Rong Luo
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, P.R. China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, China
| | - Yong-Ping Zhu
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, P.R. China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, China
| | - Guan-Hua Fang
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, P.R. China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, China
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Thilak CR, Idhrees M, Ibrahim M, Arunkumar A, Velayudhan B. Stanford type B aortic dissection in a patient with aberrant right subclavian artery. Indian J Thorac Cardiovasc Surg 2024; 40:234-237. [PMID: 38389763 PMCID: PMC10879476 DOI: 10.1007/s12055-023-01637-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 02/24/2024] Open
Abstract
An aberrant right subclavian artery is a rare aortic arch anomaly where the right subclavian artery arises from the proximal part of the descending thoracic aorta and distal to origin of left subclavian artery. It usually courses behind the esophagus. Type B aortic dissection along with aberrant right subclavian artery is not common. A middle-aged man presented with complaints of epigastric pain and on evaluation was found to have aberrant right subclavian artery with type B aortic dissection. A total arch replacement with frozen elephant trunk surgery and an extra-anatomic bypass of right subclavian artery were performed. Type B aortic dissection is more often an incidental finding and its association with aberrant right subclavian artery is unusual. Such association should be identified and treated accordingly to avert clinical complications.
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Affiliation(s)
| | - Mohammed Idhrees
- Institute of Cardiac and Aortic Disorders, SIMS Hospital, Chennai, 600026 India
| | - Mohammed Ibrahim
- Institute of Cardiac and Aortic Disorders, SIMS Hospital, Chennai, 600026 India
| | | | - Bashi Velayudhan
- Institute of Cardiac and Aortic Disorders, SIMS Hospital, Chennai, 600026 India
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Lombardi F, Mamopoulos A, Benedik J, Katoh M, Kröger K, Gäbel G. How to Treat Type B Aortic Dissections in the Presence of an Aberrant Right Subclavian Artery: A Systematic Review. AORTA (STAMFORD, CONN.) 2023; 11:20-28. [PMID: 36848908 PMCID: PMC9970753 DOI: 10.1055/s-0042-1757948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 07/06/2022] [Indexed: 06/18/2023]
Abstract
An aberrant right subclavian artery (ARSA) is the most common congenital variant of the aortic arch. Usually, this variation is largely asymptomatic, but sometimes it may be involved in aortic dissection (AD). Surgical management of this condition is challenging. The therapeutic options have been enriched in recent decades by establishing individualized endovascular or hybrid procedures. Whether these less invasive approaches bear advantages, and how they have changed the treatment of this rare pathology, is still unclear. Therefore, we conducted a systematic review. We performed a review of literature from the past 20 years (from January 2000 until February 2021) complying with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. All reported patients treated for Type B AD in the presence of an ARSA were identified and classified into three groups according to the received therapy (open, hybrid, and total endovascular). Patient characteristics, as well as in-hospital mortality, and major and minor complications were determined and statistically analyzed. We identified 32 relevant publications comprising 85 patients. Open arch repair has been offered to younger patients, but significantly less often in symptomatic patients needing urgent repair. Therefore, the maximum aortic diameter was also significantly larger in the open repair group compared with that in the hybrid or total endovascular repair group. Regarding the endpoints, we did not find significant differences. The literature review revealed that open surgical therapies are preferred in patients presenting with chronic dissections and larger aortic diameters, most likely because they are unsuitable for endovascular aortic repair. Hybrid and total endovascular approaches are more often applied in emergency situations, where aortic diameters remain smaller. All therapies demonstrated good, early, and midterm outcomes. But, these therapies carry potential risks in the long term. Therefore, long-term follow-up data are urgently needed to validate that these therapies are sustainable.
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Affiliation(s)
| | | | | | - Marcus Katoh
- Department of Diagnostic and Interventional Radiology, Helios Clinic, Krefeld, Germany
| | - Knut Kröger
- Department of Vascular Medicine, Helios Clinic, Krefeld, Germany
| | - Gabor Gäbel
- Department of Vascular Surgery, Helios Clinic, Krefeld, Germany
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A systematic review of open, hybrid, and endovascular repair of aberrant subclavian artery and Kommerell's diverticulum treatment. J Vasc Surg 2023; 77:642-649.e4. [PMID: 35850164 DOI: 10.1016/j.jvs.2022.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/16/2022] [Accepted: 07/07/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Aberrant subclavian artery (AScA) with or without associated Kommerell's diverticulum (KD) is the most frequently encountered anomaly of the aortic arch, it may be life threatening, especially when associated with aneurysmal degeneration. The best management is still debated and depends on many clinical and anatomical factors. A systematic review was conducted to assess the current evidence on the treatment options and their efficacy and safety for AscA and KD repairs. METHODS A literature search in PubMed and Cochrane Library was performed, and articles that were published from January 1947 to August 2021 reporting on AscA and KD management were identified. Multicenter studies, single-center series, and case series with three or more patients were considered eligible in the present review. A comparison of outcomes of patients who underwent open surgery (OS), a hybrid approach (HA), and total endovascular repair (ER) (ie, 30-day mortality and stroke were analyzed when available and compared among the three groups (P < .05; Benjamini and Hochberg-adjusted P < .05; Bonferroni-adjusted P < .05). Titles, abstracts, and full texts were evaluated by two authors independently. Primary outcomes included survival rate, perioperative stroke, arm ischemia, and spinal cord ischemia. Endoleak, in the case of HA and ER, and reintervention rates were considered outcomes. RESULTS Three hundred thirty-one articles were initially evaluated and 30 studies, totaling 426 patients treated for AScA with 324 KD, were included. Of the 426 patients, 241 were male (56.5%), and the mean patient age was 57.9 ± 12.0 years. The approach was OS in 228 patients, HA in 147 patients, and ER in 51. Dysphagia was the most common presentation in 133 cases. Aortic rupture was observed in 16 of the 426 patients (3.8%), including 14 AScA/KD (3.3%) aneurysm rupture. KD maximum diameter varied widely from 12.6 to 63.6 mm. The overall 30-day mortality was 20 (4.7%) (OS group 8/228 [3.5%]; HA group 10/147 [6.8%]; ER 2/51 [3.9%]; P = NS). The overall stroke rate was 4.9% (21/426) (OS group 10/228 [4.4%]; HA group 6/147 [4.1%]; ER group 5/51 [9.8%]; P = NS), including nine transient and nondisabling neurological deficits. Overall secondary procedures for complications were reported in 36 of the 426 cases (8.4%), mostly owing to endoleak. Follow-up varied from 13 to 74 months. CONCLUSIONS This systematic review assessed the current outcomes of the three types of therapeutic management for AScA and KD and demonstrated that they are all relatively safe and effective, providing satisfactory early and midterm outcomes. Long-term outcomes are warranted, especially for total ERs since the long-term durability of stent grafts remains unknown.
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Cook V, Singla AA, Herlihy D, Chui J, Fisher C, Puttaswamy V. Involvement of Kommerell's diverticulae-a new anatomical risk factor for acute aortic syndrome progression and technical considerations. J Surg Case Rep 2022; 2022:rjac489. [PMID: 36324766 PMCID: PMC9618310 DOI: 10.1093/jscr/rjac489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/27/2022] [Accepted: 10/02/2022] [Indexed: 01/24/2023] Open
Abstract
We present two cases of acute aortic syndromes (AAS), involving an aberrant right subclavian artery (ARSA) with associated Kommerell's diverticulae (KD). One of the cases involves a penetrating aortic ulcer in patients with an ARSA and KD and represents the first reported such case in the literature. Both cases progressed despite optimal medical therapy suggesting AAS with this anomalous anatomy needs a more aggressive operative approach. The involvement of KD in a patient with AAS appears to increase aortic disease progression and this anatomical variation should be considered another anatomical criterion that may place these patients at higher risk of complication. Progression during conservative management and waiting for the patient to be in the traditional safer 'sub-acute' time frame after presentation increased the eventual difficulty of the hybrid repair. A hybrid open-endovascular repair was utilized in all cases and is a safe and effective strategy for managing patients with ARSA and KD presenting with AAS.
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Affiliation(s)
- Victoria Cook
- Department of Vascular Surgery, Royal North Shore Hospital, Sydney, NSW 2065, Australia
| | - Animesh A Singla
- Correspondence address. 77 Donovan Avenue, Maroubra, NSW 2035, Australia. Tel: +61497453757; E-mail:
| | - David Herlihy
- Department of Vascular Surgery, Royal North Shore Hospital, Sydney, NSW 2065, Australia
| | - Juanita Chui
- Department of Vascular Surgery, Royal North Shore Hospital, Sydney, NSW 2065, Australia,Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2065, Australia
| | - Charles Fisher
- Department of Vascular Surgery, Royal North Shore Hospital, Sydney, NSW 2065, Australia
| | - Vikram Puttaswamy
- Department of Vascular Surgery, Royal North Shore Hospital, Sydney, NSW 2065, Australia
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Zhang X, Chen D, Wu M, Dong H, Wan Z, Jia H, Liang S, Shao J, Zheng J, Xu S, Xiong J, Guo W. Functional Evaluation of Embedded Modular Single-Branched Stent Graft: Application to Type B Aortic Dissection With Aberrant Right Subclavian Artery. Front Cardiovasc Med 2022; 9:869505. [PMID: 35586645 PMCID: PMC9108238 DOI: 10.3389/fcvm.2022.869505] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Endovascular repair of type B aortic dissection (TBAD) with aberrant right subclavian artery (ARSA) is challenging due to anatomical complexity. The embedded modular single-branched stent graft (EMSBSG) could solve this problem. However, the hemodynamic efficacy of this innovative technique has not been fully assessed. This study aimed to propose morphometric and functional indicators to quantify the outcomes of EMSBSG in treating TBAD with ARSA. Material and Methods A patient who had TBAD with ARSA underwent EMSBSG implantation was admitted. Computational fluid dynamics (CFD) and three-dimensional structural analyses were conducted based on CTA datasets before the operation (Pre-1) and at 4 and 25 days after EMSBSG implantation (Post-1 and Post-2). Quantitative and qualitative functional analyses were conducted via pressure-, velocity- and wall shear stress (WSS) -based parameters, such as the luminal pressure difference (LPD), total energy loss, and flow distribution ratio. By precisely registering the aortas at the three time points, parameter variations in the EMSBSG region were also computed to investigate the prognostic improvement after EMSBSG implantation. Results The first balance point of LPD distally shifted to the abdominal aorta in Post-1 by a distance of 20.172 cm, and shifted out of the dissected region in Post-2, indicating positive pressure recovery post EMSBSG. The flow distribution ratios of all aortic arch branches increased after EMSBSG implantation. A positive normal deformation index in the EMSBSG region confirmed true lumen expansion; dominant ARN (area ratio of negative value) of pressure and WSS-based parameters indicated an improved prognosis from Post-1 to Post-2. Conclusions The short-term results of EMSBSG in treating TBAD with ARSA proved to be promising, especially in EMSBSG region. Comprehensive evaluation could provide new insight into the therapy of TBAD with ARSA. Thus, it might guide the further management of complex aortic arch lesions.
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Xu X, Wang D, Hou N, Zhou H, Li J, Tian L. Thoracic Endovascular Aortic Repair for Aberrant Subclavian Artery and Stanford Type B Aortic Intramural Hematoma. Front Surg 2022; 8:813970. [PMID: 35223970 PMCID: PMC8878622 DOI: 10.3389/fsurg.2021.813970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/28/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives To 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). Methods In 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. Results The 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. Conclusion Thoracic 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.
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Affiliation(s)
- Xia Xu
- Department of Cardiothoracic and Vascular Surgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Daoquan Wang
- Department of Cardiothoracic and Vascular Surgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Ningxin Hou
- Department of Cardiothoracic and Vascular Surgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Hongmin Zhou
- Department of Cardiothoracic and Vascular Surgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Li
- Department of Cardiothoracic and Vascular Surgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Liang Tian
- Department of Neurosurgery, Taikang Tongji (Wuhan) Hospital, Wuhan, China
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Pang X, Qiu S, Wang C, Liu K, Zhao X, Fang C. Endovascular Aortic Repair With Castor Single-Branched Stent-Graft in Treatment of Acute Type B Aortic Syndrome and Aberrant Right Subclavian Artery. Vasc Endovascular Surg 2021; 55:551-559. [PMID: 33764219 DOI: 10.1177/15385744211005664] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In this retrospective study, we presented the results of Castor single-branched stent-graft in a small series of patients with acute type B aortic syndrome and aberrant right subclavian artery (ARSA). METHODS Between January 2019 and November 2019, 5 patients were diagnosed with acute type B aortic syndrome and ARSA (4 patients with intramural hematoma and ARSA, 1 patient with type B aortic dissection and ARSA). All the patients underwent thoracic endovascular aortic repair (TEVAR) using Castor single-branched stent-graft. In-hospital and 3-month outcomes were collected. RESULTS The mean operative time was 116 ± 20.43 minutes (range 90-145). All the TEVAR procedures were successfully performed without conversion to open surgery (100% success rate). All the ARSAs of the 5 patients were revascularized in situ by Castor single-branched stent-grafts. No deaths and complications were observed in the 3-month follow-up. The maximal diameters of diseased aortas in the 4 patients with IMH decreased 3 months after TEVAR. The false lumen in the graft-covered segment was completely thrombosed in the patient with type B aortic dissection. CONCLUSIONS Castor single-branched stent-graft may be a good choice in treatment of acute type B aortic syndrome and aberrant right subclavian artery.
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Affiliation(s)
- Xinyan Pang
- Department of Cardiovascular Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Shi Qiu
- Department of Cardiovascular Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Chen Wang
- Department of Cardiovascular Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Kai Liu
- Department of Cardiovascular Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xin Zhao
- Department of Cardiovascular Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Changcun Fang
- Department of Cardiovascular Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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Tong G, Zhuang DL, Sun ZC, Chen ZR, Fan RX, Sun TC. Femoral artery cannulation as a safe alternative for aortic dissection arch repair in the era of axillary artery cannulation. J Thorac Dis 2021; 13:671-680. [PMID: 33717540 PMCID: PMC7947520 DOI: 10.21037/jtd-20-2113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/18/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND To evaluate the safety and efficacy of femoral artery cannulation as an alternative to axillary artery cannulation, we retrospectively compared outcomes between patients with axillary or femoral artery cannulation during open aortic arch repair for type A aortic dissection (TAAD). METHODS Between January 2014 and January 2019, 646 patients underwent open aortic arch repair with circulatory arrest for TAAD using antegrade selective cerebral perfusion (SACP) and were divided into two groups according to the site of arterial cannulation: an axillary artery group (axillary group, n=558) or a femoral artery group (femoral group, n=88). The axillary artery was considered as the primary cannulation site, and the femoral artery was used as an alternative when axillary artery cannulation was deemed unsuitable or had failed. Propensity score matching was performed to correct baseline differences. RESULTS After propensity score matching, the patients' characteristics were comparable between groups (n=85 in each). The incidence of in-hospital mortality (10.6% vs. 14.1%; P=0.642) and stroke (3.5% vs. 5.9%; P=0.720) were comparable between the axillary and femoral groups. The incidence of newly required dialysis was lower in the femoral group, but the difference was not statistically significant (34.1% vs. 20.0%; P=0.050). Other outcomes and major adverse events were comparable. CONCLUSIONS Femoral artery cannulation produced similar perioperative outcomes to axillary cannulation after open arch repair for TAAD. The femoral artery can be used as a safe and effective alternative to the axillary artery for arterial cannulation in TAAD patients undergoing open arch repair.
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Affiliation(s)
- Guang Tong
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Dong-Lin Zhuang
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Zhong-Chan Sun
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ze-Rui Chen
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Rui-Xin Fan
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Tu-Cheng Sun
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Tigkiropoulos K, Kousidis P, Lazaridis I, Saratzis N. Hybrid Repair of Distal Aortic Arch Dissection Aneurysm With Dissected Kommerell Diverticulum. Vasc Endovascular Surg 2020; 54:375-377. [PMID: 32270759 DOI: 10.1177/1538574420911261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aberrant right subclavian artery (ARSA) with associated Kommerell diverticulum (KD) is a rare congenital aortic arch anomaly. Patients with KD have a high risk of rupture, dissection, compression of adjacent structures, as well as distal embolization symptoms. Several treatment options have been proposed (surgical, hybrid, endovascular), however, a consensus regarding optimal surgical management has not been established yet. We present a successful single-stage hybrid repair of distal aortic arch dissection aneurysm with dissecting KD and ARSA with debranching of innominate and left common carotid artery, bilateral carotid-subclavian bypass, and stent grafting.
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Affiliation(s)
- Konstantinos Tigkiropoulos
- Vascular Unit, 1st University Surgical Department, Aristotle University, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Panagiotis Kousidis
- Vascular Unit, 1st University Surgical Department, Aristotle University, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Ioannis Lazaridis
- Vascular Unit, 1st University Surgical Department, Aristotle University, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Nikolaos Saratzis
- Vascular Unit, 1st University Surgical Department, Aristotle University, Papageorgiou General Hospital, Thessaloniki, Greece
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Li JR, Ma WG, Chen Y, Zhu JM, Zheng J, Xu SD, Liu YM, Sun LZ. Total arch replacement and frozen elephant trunk for aortic dissection in aberrant right subclavian artery. Eur J Cardiothorac Surg 2020; 58:104-111. [PMID: 32057078 DOI: 10.1093/ejcts/ezaa029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 01/02/2020] [Accepted: 01/09/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
Aortic dissection (AoD) in the presence of an aberrant right subclavian artery (ARSA) is very rare. Clinical experience is limited, and there is no consensus regarding the optimal management strategy. We seek to evaluate the safety and efficacy of the total arch replacement (TAR) and frozen elephant trunk (FET) technique as an approach to AoD in patients with ARSA by retrospectively analysing our single-centre experience.
METHODS
From 2009 to 2017, we performed TAR + FET for 22 patients with ARSA sustaining AoD (13 acute, 59.1%). The mean age was 46.0 years [standard deviation (SD) 8.3], and 19 patients were male (86.4%). ARSA orifice was dilated in 15 (68.2%) patients, and a Kommerall diverticulum was diagnosed in 13 (59.1%) patients with a mean diameter of 21.8 mm (SD 7.7; range 15–40). Surgery was performed via femoral and right/left carotid cannulation under hypothermic circulatory arrest at 25°C. The ARSA was reconstructed using a separate branched graft.
RESULTS
ARSA was closed proximally by ligation in 16 (72.7%) patients, direct suture in 4 (18.2%) patients and both in 2 (9.1%) patients. Operative mortality was 13.6% (3/22). Type Ib endoleak occurred in 1 (4.5%) patient at 8 days. Follow-up was complete in 100% at mean 4.2 years (SD 2.0), during which 3 late deaths and 1 reintervention for type II endoleak occurred. Survival was 81.8% and 76.4% at 3 and 5 years, respectively. Freedom from reoperation was 89.2% up to 8 years. In competing risks analysis, the incidence was 22.1% for death, 10.8% for reoperation and 67.1% for event-free survival at 5 years. The false lumen, ARSA orifice and Kommerall diverticulum were obliterated in 100%. Grafts were patent in 100%. No patients experienced cerebral ischaemia and upper extremity claudication. Hypothermic circulatory arrest time (min) was sole predictor for death and aortic reintervention (hazard ratio 1.168, 95% confidence interval 1.011–1.348; P = 0.034).
CONCLUSIONS
The TAR and FET technique is a safe and efficacious approach to AoD in patients with ARSA. Modifications of routine TAR + FET techniques are essential to successful repair, including femoral and right/left carotid artery cannulation, ligation of ARSA on the right side of the trachea and ARSA reconstruction with a separate graft.
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Affiliation(s)
- Jian-Rong Li
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Wei-Guo Ma
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Yu Chen
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Jun-Ming Zhu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Jun Zheng
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Shang-Dong Xu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Yong-Min Liu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Li-Zhong Sun
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
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Abuharb MYI, Ming BX, Jian H. Repair of a type B aortic dissection with a re-vascularization of the aberrant right subclavian artery in an adult patient. J Cardiothorac Surg 2019; 14:201. [PMID: 31771609 PMCID: PMC6880428 DOI: 10.1186/s13019-019-1031-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 11/18/2019] [Indexed: 12/27/2022] Open
Abstract
Background An aberrant right subclavian artery which arises from the proximal descending aorta may result in aortic dissection. The dissection may occur at either the site of the primary intimal tear or from an aortic branch. These conditions may lead to blood flow limitation and possible aneurysmal degeneration in the future. Case presentation We described the clinical presentation and management of a 54-year old patient diagnosed with a rare case of an aberrant right subclavian artery with Stanford Type B aortic dissection. A hybrid surgical approach was successfully performed and the patient had an uneventful recovery. Conclusion Even though aortic dissection is often an incidental finding, this case highlighted that in rare situations, it can be associated with an aberrant right subclavian artery. It is important to disseminate this association as it has profound diagnostic and therapeutic implications in safeguarding the clinical outcomes of patients with such condition.
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Affiliation(s)
- Mahmoud Yousef Ibrahim Abuharb
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Dalian Medical University, Lianhe Avenue, Dalian, China
| | - Bian Xiao Ming
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Dalian Medical University, Lianhe Avenue, Dalian, China
| | - He Jian
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Dalian Medical University, Zhongshan Avenue 222, Dalian, China.
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Huang M, Piao H, Li B, Wang Y, Wang T, Zhu Z, Li D, Liu K. A new inclusion technique through an upper partial sternotomy for complicated Stanford B-type aortic dissection with an aberrant right subclavian artery: A case report. Medicine (Baltimore) 2019; 98:e14727. [PMID: 30882638 PMCID: PMC6426566 DOI: 10.1097/md.0000000000014727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
RATIONALE An aberrant right subclavian artery (ARSA), arising from the proximal descending aorta, is a common aortic arch anomaly, with an incidence of 0.5% to 2%. However, coexistence of dissection and an ARSA is extremely rare. We presented the first case of successful management of complicated Stanford B-type aortic dissection combined with an ARSA with a new inclusion technique and stent graft (SG) implantation through an upper partial sternotomy. PATIENT CONCERNS A 39-year-old woman with a history of severe hypertension was admitted to our hospital because of sudden-onset chest and upper back pain. DIAGNOSES Aortic computed tomography angiography (CTA) demonstrated complicated Stanford B-type dissection with ARSA. INTERVENTIONS A new inclusion technique and SG implantation through an upper partial sternotomy were performed for the patient, whose aortic arch branch vessels, including ARSA, were fully preserved. OUTCOMES The patient had an uneventful postoperative course without neurologic deficits, and no blood transfusion was required during the hospitalization. The false lumen completely disappeared on postoperative CTA. LESSONS This new inclusion technique through an upper partial sternotomy is a safe and feasible treatment for complicated Stanford B-type aortic dissection with an ARSA with the primary tear located in the aortic arch.
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Ding H, Luo S, Liu Y, Huang W, Jiang M, Li J, Xie N, Fan X, Fan R, Luo J. Outcomes of hybrid procedure for type B aortic dissection with an aberrant right subclavian artery. J Vasc Surg 2018; 67:704-711. [DOI: 10.1016/j.jvs.2017.07.124] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/18/2017] [Indexed: 12/15/2022]
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Zhou M, Bai X, Ding Y, Wang Y, Lin C, Yan D, Shi Z, Fu W. Morphology and Outcomes of Total Endovascular Treatment of Type B Aortic Dissection with Aberrant Right Subclavian Artery. Eur J Vasc Endovasc Surg 2017; 54:722-728. [DOI: 10.1016/j.ejvs.2017.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 09/25/2017] [Indexed: 12/11/2022]
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Ding X, Hu S, Jiang J. Endovascular Repair with Periscope Technique for Aortic Dissection with an Aberrant Right Subclavian Artery. Ann Vasc Surg 2017; 45:264.e9-264.e13. [DOI: 10.1016/j.avsg.2017.06.122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 02/27/2017] [Accepted: 06/18/2017] [Indexed: 01/07/2023]
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Boysan E, Circi R. Reliability of axillary artery cannulation. Eur J Cardiothorac Surg 2017; 52:830. [PMID: 28605538 DOI: 10.1093/ejcts/ezx185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 05/10/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Emre Boysan
- Department of Cardiovascular Surgery, Liv Hospital, Ankara, Turkey
| | - Renda Circi
- Department of Cardiovascular Surgery, Liv Hospital, Ankara, Turkey
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