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Vinod P, Patel H. A Novel Case of Anomalous Origin of Left Vertebral Artery Associated With Left Subclavian Steal Syndrome. Cardiol Res 2024; 15:205-209. [PMID: 38994224 PMCID: PMC11236351 DOI: 10.14740/cr1672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 06/15/2024] [Indexed: 07/13/2024] Open
Abstract
The subclavian steal syndrome (SSS) is defined by the reversal of flow in the ipsilateral vertebral artery in the setting of subclavian artery stenosis proximal to its origin. Here, we describe a rare case of left SSS with significant left subclavian artery stenosis associated with anomalous origin of the left vertebral artery (LVA) directly from the aortic arch in a patient presenting with signs of vertebrobasilar insufficiency and resolution of symptoms following angioplasty. Through this case, the authors try to emphasize the importance and the correct technique of using Doppler ultrasonography, and the importance of invasive angiography in understanding the mechanism of subclavian steal in patients with anomalous LVA origin.
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Affiliation(s)
- Poornima Vinod
- Department of Internal Medicine, University of North Carolina Health at Southeastern, Lumberton, NC 28358, USA
| | - Hiten Patel
- Division of Interventional Cardiology, University of North Carolina Health at Southeastern, Lumberton, NC 28358, USA
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Triantafyllou G, Melissanidis S, Vlychou M, Tsakotos G, Pantazis N, Vassiou K, Tsiouris C, Piagkou M. Right-Sided Aortic Arch: A Computed Tomography Angiography Investigation, A Systematic Review with Meta-Analysis. J Clin Med 2024; 13:3105. [PMID: 38892815 PMCID: PMC11172921 DOI: 10.3390/jcm13113105] [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: 04/24/2024] [Revised: 05/14/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: The right-sided aortic arch (RAA) is an uncommon variation of the aortic arch (AA), characterized by the aorta crossing over the right main bronchus. In the RAA, the descending aorta can be found on either the right or left side of the spine. The current study comprises a comprehensive retrospective computed tomography angiography (CTA) investigation into the prevalence of the RAA within the Greek population. Additionally, we will conduct a systematic review and meta-analysis to elucidate both common and rare morphological variants of the RAA. This research is significant as it sheds light on the prevalence and characteristics of the RAA in a specific population, providing valuable insights for clinical practice. Methods: Two hundred CTAs were meticulously investigated for the presence of a RAA. In addition, the PubMed, Google Scholar, and Scopus online databases were thoroughly searched for studies referring to the AA morphology. The R programming language and RStudio were used for the pooled prevalence meta-analysis, while several subgroup analyses were conducted. Results: Original study: A unique case of 200 CTAs (0.5%) was identified with an uncommon morphology. The following branches emanated from the RAA under the sequence: the right subclavian artery (RSA), the right common carotid artery (RCCA), the left common carotid artery (LCCA), and the left vertebral artery (LVA) in common origin with the aberrant left subclavian artery (ALSA). The ALSA originated from a diverticulum (of Kommerell) and followed a retroesophageal course. Systematic Review and Meta-Analysis: Sixty-two studies (72,187 total cases) met the inclusion criteria. The pooled prevalence of the RAA with a mirror-image morphology was estimated at 0.07%, and the RAA with an ALSA was estimated at <0.01%. Conclusions: AA anomalies, specifically the RAA, raise clinical interest due to their coexistence with developmental heart anomalies and possible interventional complications. Congenital heart anomalies, such as the Tetralogy of Fallot and patent foramen ovale, coexisted with RAA mirror-image morphology.
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Affiliation(s)
- George Triantafyllou
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (G.T.); (C.T.)
| | | | - Marianna Vlychou
- Department of Radiology, University Hospital of Larissa, 413 34 Larissa, Greece;
| | - George Tsakotos
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (G.T.); (C.T.)
| | - Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian, University of Athens, 115 27 Athens, Greece;
| | - Katerina Vassiou
- Department of Anatomy, Faculty of Medicine, University of Thessaly, 413 34 Larissa, Greece;
| | - Christos Tsiouris
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (G.T.); (C.T.)
| | - Maria Piagkou
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (G.T.); (C.T.)
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Luo ZR, Li SL, Chen LW, Huang RD. Utilizing physician modified fenestration on the castor branched stent technique for reconstruction of an isolated left vertebral artery on the aortic arch. Sci Rep 2024; 14:4051. [PMID: 38374192 PMCID: PMC10876643 DOI: 10.1038/s41598-024-54781-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/16/2024] [Indexed: 02/21/2024] Open
Abstract
The study aimed to provide physician modified fenestration (PMF) on a single-branched stent for the aortic arch (Castor) to protect the isolated left vertebral artery (ILVA) during thoracic endovascular aortic repair (TEVAR). Patients who underwent TEVAR involving ILVA reconstruction through PMF performing on the Castor branched stent were included in a retrospective, multi-centre study from June 2018 to December 2022. In these patients, all proximal landing zones of "Castor" were positioned in Ishimaru zone 2a. A total of twenty-five patients met the inclusion criteria and the achievement rate showed 25/25 (100%) success in them. The twenty-five patients had a median follow-up length of 28.5 ± 14.6 months. One patient (4.0%) suffered from postoperative ischemic stroke before discharge. One patient (4.0%) died from a hemodialysis-related brain hemorrhage before discharge on the 29th day after the procedure. One patient died of advanced liver cancer in the 33th month after discharge. Aortic rupture, stroke or spinal cord injury did not occur throughout the follow-up period after discharge. Two patients (8.0%) experienced endoleak at the fenestration, however, resulting in only one's necessity for reintervention. Notably, the procedure effectively maintained ILVAs patency for all patients during follow up. According to our preliminary findings, performing a TEVAR under local anaesthesia using PMF on a Castor branched stent for ILVA preservation appeared practical, secure, and effective.
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Affiliation(s)
- Zeng-Rong Luo
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fuzhou, Fujian Province, China
| | - Sai-Lan Li
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fuzhou, Fujian Province, China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fuzhou, Fujian Province, China
| | - Rong-Da Huang
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China.
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fuzhou, Fujian Province, China.
- Department of Cardiovascular Surgery and Cardiac Disease Center, Fujian Medical University Union Hospital, Fuzhou, 350001, China.
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Zhang J, Zhang A, Wang Z, Sun Y, Li X, Jin Q, Shi J, Hou J, Zhang L, Yang B. A Comparative Study of Clinical and Aortic Morphological Characteristics between Bovine Aortic Arch and Normal Aortic Arch in Patients with Acute Type B Aortic Dissection. Cardiology 2023; 148:409-417. [PMID: 37385225 DOI: 10.1159/000531731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/19/2023] [Indexed: 07/01/2023]
Abstract
INTRODUCTION The purpose of this study was to analyze the difference in clinical and aortic morphological features between the bovine aortic arch and normal aortic arch in patients with acute type B aortic dissection (aTBAD). METHODS A total of 133 patients diagnosed with aTBAD were retrospectively collected. Based on aortic arch morphology, they were divided into the bovine aortic arch group (n = 20) and the normal aortic arch group (n = 113). Aortic morphological features were assessed on computed tomographic angiography. Clinical and aortic morphological features were then compared between the bovine aortic arch and normal aortic arch groups. RESULTS Patients in the bovine aortic arch group were significantly younger and with higher weight and BMI than the normal aortic arch group (p < 0.001, p = 0.045, and p = 0.016, respectively). The total aortic length in the bovine aortic arch group was significantly shorter than that in the normal aortic arch group (p = 0.039). The tortuosity of descending thoracic aorta, the tortuosity of descending aorta, and the angulation of aortic arch were significantly lower in the bovine aortic arch group (p = 0.004, p = 0.015, and p = 0.023, respectively). The width of descending aorta, the height of aorta arch, and the angle of ascending aorta were significantly smaller in the bovine aortic arch group (p = 0.045, p = 0.044, and p = 0.042, respectively). CONCLUSION When the aTBAD occurred, patients with bovine aortic arch were prone to be younger and with higher BMI than those with normal aortic arch. The aortic curvature and the total aortic length were lower in patients with bovine aortic arch.
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Affiliation(s)
- Jianhua Zhang
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, China Medical University, Shenyang, China
| | - Anxiaonan Zhang
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, China Medical University, Shenyang, China
| | - Zhenguo Wang
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, China Medical University, Shenyang, China
| | - Yu Sun
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
- Key Laboratory of Cardiovascular Imaging and Research, Liaoning Province, Shenyang, China
| | - Xiaogang Li
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
- Key Laboratory of Cardiovascular Imaging and Research, Liaoning Province, Shenyang, China
| | - Qiuyue Jin
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, Jinzhou Medical University, Jinzhou, China
| | - Jinglong Shi
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, Jinzhou Medical University, Jinzhou, China
| | - Jie Hou
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
- Key Laboratory of Cardiovascular Imaging and Research, Liaoning Province, Shenyang, China
| | - Libo Zhang
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
- Key Laboratory of Cardiovascular Imaging and Research, Liaoning Province, Shenyang, China
| | - Benqiang Yang
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
- Key Laboratory of Cardiovascular Imaging and Research, Liaoning Province, Shenyang, China
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Tasdemir R, Cihan ÖF, Ince R, Sevmez F. Anatomical Variations in Aortic Arch Branching Pattern: A Computed Tomography Angiography Study. Cureus 2023; 15:e36731. [PMID: 37123663 PMCID: PMC10131257 DOI: 10.7759/cureus.36731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Variations in the branching pattern of the aortic arch (AA) are common. Modification of intravascular stents should be considered taking into account these AA branching variations. Identification of supra-aortic branching types and frequencies is important for specialists planning surgery in this region. In endovascular interventions to the AA, aortic stent grafts should be modified according to the variations of the branching patterns of the AA. In any surgical intervention to the region where the supra-aortic branches are located, ignorance of the variations may cause unwanted injuries or complications. METHODS In this study, 699 computed tomography angiography (CTA) images were reviewed to investigate AA branching variations using the Horos software (an open-source image viewer). Four groups were constructed based on the number of branches emerging from the aortic arch, which were further divided into subtypes. RESULTS A total of 699 CTA images from 320 males and 379 females were included in this study. The usual AA branching pattern (type 3b1) was found in 68.5% of the patients. The combined prevalence of other eight branching patterns, designated as variations, was 31.5%. Variation types 1b1, 3b2, and 4b5 were identified in one patient each. Overall, types 2b1 and 2b2 had a prevalence of 28.3%. The type 2b3 variation was observed in 1.6% of the patients. The least common variations were type 4b1 (0.7%) and type 3b2 (0.1%). CONCLUSION The identification of variations in AA branching patterns by CTA prior to surgical or endovascular interventions involving the aortic arch is important. Thus, specialists planning interventions in this region need to be aware and have knowledge of atypical aortic branching patterns. Higher prevalence rates of AA branching patterns compared to previous studies were identified in the Turkish population in this study and therefore, a comprehensive, multicenter study is needed to determine the cause of this differential finding.
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Shen P, Li D, Wu Z, He Y, Wang X, Shang T, Zhu Q, Tian L, Li Z, Zhang H. Physician-modified fenestration or in situ fenestration for preservation of isolated left vertebral artery in thoracic endovascular aortic repair. Front Cardiovasc Med 2023; 10:1055549. [PMID: 37063949 PMCID: PMC10098321 DOI: 10.3389/fcvm.2023.1055549] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 03/08/2023] [Indexed: 04/18/2023] Open
Abstract
Objective To present our experience of preserving the isolated left vertebral artery (ILVA) with physician-modified fenestration (PM-F) or in situ fenestration (ISF) during thoracic endovascular aortic repair (TEVAR) for aortic pathologies involving aortic arch. Methods This is a single-center, retrospective, observational cohort study. Between June 2016 and December 2021, 9 patients (8 men; median age 60.0 years old) underwent TEVAR with ILVA reconstruction (PM-F, n = 6; ISF, n = 3) were identified and analyzed. Results The technical success rate was 100%. No early (<30 days) death occurred. No aortic rupture, major stroke or spinal cord injury was observed. The median follow up was 38.0 (rang: 1.0-66.0) months. One death occurred at 56 months, while the reason cannot be identified. No aortic rupture, major stroke or spinal cord injury was observed during follow up. No patient required reintervention. Out of the 22 successfully revascularized target vessels, 2 ILVAs were found occluded in 2 patients at 6 months and 7 months, respectively. However, these two patients were asymptomatic. Conclusions Our initial experience reveals that PM-F or ISF for ILVA preservation was feasible, safe, and effective during TEVAR for complex thoracic aortic pathologies. However, the patency of preserved ILVA should be improved.
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Affiliation(s)
- Peier Shen
- Department of Nursing, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Donglin Li
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ziheng Wu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yangyan He
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaohui Wang
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Tao Shang
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qianqian Zhu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lu Tian
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhenjiang Li
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Correspondence: Zhenjiang Li Hongkun Zhang
| | - Hongkun Zhang
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Correspondence: Zhenjiang Li Hongkun Zhang
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Saleh QW, Diederichsen ACP, Lindholt JS. Individualized prediction of risk of ascending aortic syndromes. PLoS One 2022; 17:e0270585. [PMID: 35759492 PMCID: PMC9236241 DOI: 10.1371/journal.pone.0270585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 06/13/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives Although ascending aortic diameter changes acutely after dissection, recommendation for prophylactic surgery of thoracic aortic aneurysms rely on data from dissected aortas. In this case-control study we aim to identify risk markers for acute and chronic aortic syndromes of the ascending aorta (ACAS-AA). Furthermore, to develop a predictive model for ACAS-AA. Methods We collected data of 188 cases of ACAS-AA and 376 controls standardized to age- and sex of the background population. Medical history and CT-derived aortic morphology were collected. For the dependent outcome ACAS-AA, potential independent risk factors were identified by univariate logistic regression and confirmed in multivariate logistic regression. As post-dissection tubular ascending aortic diameter is prone to expand, this factor was not included in the first model. The individual calculated adjusted odds ratios were then used in ROC-curve analysis to evaluate the diagnostic accuracy of the model. To test the influence of post-ACAS-AA tubular ascending aortic diameter, this was added to the model. Results The following risk factors were identified as independent risk factors for ACAS-AA in multivariate analysis: bicuspid aortic valve (OR 20.41, p = 0.03), renal insufficiency (OR 2.9, p<0.01), infrarenal abdominal aortic diameter (OR 1.08, p<0.01), left common carotid artery diameter (OR 1.40, p<0.01) and aortic width (OR 1.07, p<0.01). Area under the curve was 0.88 (p<0.01). Adding post-ACAS-AA tubular ascending aortic diameter to the model, negated the association of bicuspid aortic valve, renal insufficiency, and left common carotid artery diameter. Area under the curve changed to 0.98 (p<0.01). Conclusions A high performing predictive model for ACAS-AA, free of ascending aortic diameter, can be achieved. Furthermore, we have identified abdominal aortic ectasia as an independent risk factor of ACAS-AA. Integration of potential biomarkers and morphologic variables, derived from undissected aortas, would probably improve the model.
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Affiliation(s)
- Qais Waleed Saleh
- Department of Thoracic-, Cardiac- and Vascular Surgery, Odense University Hospital, Odense, Denmark
- Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense, Denmark
- Centre of Clinical Excellence in Southern Denmark (CAVAC), Odense, Denmark
- * E-mail:
| | - Axel Cosmus Pyndt Diederichsen
- Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense, Denmark
- Centre of Clinical Excellence in Southern Denmark (CAVAC), Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jes Sanddal Lindholt
- Department of Thoracic-, Cardiac- and Vascular Surgery, Odense University Hospital, Odense, Denmark
- Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense, Denmark
- Centre of Clinical Excellence in Southern Denmark (CAVAC), Odense, Denmark
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Tsiouris C, Lazaridis N, Piagkou M, Duparc F, Antonopoulos I, Antonitsis P, Natsis K. The left-sided aortic arch variants: prevalence meta-analysis of imaging studies. Surg Radiol Anat 2022; 44:673-688. [PMID: 35486163 DOI: 10.1007/s00276-022-02945-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/07/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To estimate the prevalence of the left-sided aortic arch (LSAA) variants, and the effect of possible moderators on variants' detection. METHODS A systematic online literature search was conducted. The pooled prevalence with 95% confidence intervals was estimated for the typical and atypical branching patterns to compare the overall proportions of different variants. Meta-regression analyses were performed to investigate the effect of the subjects' gender and geographical region, and the multidetector computed tomography (MDCT) scanner's technology on the estimated prevalence. RESULTS In total, 18,075 cases from 23 imaging studies were included and 33 different LSAA variants were detected. The estimated heterogeneity was statistically significant. Based on the estimated prevalence, approximately 77% of the population is expected to have the typical branching anatomy with sequence brachiocephalic trunk-left common carotid artery-left subclavian artery, and 23% variant branching patterns. Approximately 71%, 23%, 2%, and 0.1% of the atypical populations are expected to have two, four, three, and five emerging branches, respectively. The meta-regression analyses showed that the number of detector rows of the MDCT scanner, and the subjects' geographical region are statistically significant moderators of the estimated prevalence. CONCLUSION The current findings indicate that the prevalence of the LSAA variant branching anatomy is significantly affected by the subjects' geographical region and the MDCT scanner's technological improvement, with the advanced scanners to facilitate the detection of the aortic arch variants. However, due to the heterogeneity among studies, further research is required.
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Affiliation(s)
- Christos Tsiouris
- Department of Anatomy, Faculty of Health Sciences, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Lazaridis
- Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, P.O. Box 300, 54124, ThessalonÃki, Greece.
| | - Maria Piagkou
- Department of Anatomy, Faculty of Health Sciences, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Fabrice Duparc
- Laboratory of Anatomy, Faculty of Medicine-Pharmacy, Rouen-Normandy University, Rouen, France
| | - Ioannis Antonopoulos
- Department of Anatomy, Faculty of Health Sciences, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Polychronis Antonitsis
- Cardiothoracic Department, AHEPA University General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Natsis
- Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, P.O. Box 300, 54124, ThessalonÃki, Greece
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Yang G, Chen H, Sun G, Lou W, Chen X, Zhang L. Transposition of Isolated Left Vertebral Artery in Hybrid Thoracic Endovascular Aortic Repair. Front Cardiovasc Med 2022; 8:783656. [PMID: 34970610 PMCID: PMC8712499 DOI: 10.3389/fcvm.2021.783656] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
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.
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Affiliation(s)
- Guangmin Yang
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hongwei Chen
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Guangxiao Sun
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Wensheng Lou
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xin Chen
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Leiyang Zhang
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Açar G, Çiçekcibaşı AE, Uysal E, Koplay M. Anatomical variations of the aortic arch branching pattern using CT angiography: a proposal for a different morphological classification with clinical relevance. Anat Sci Int 2021; 97:65-78. [PMID: 34505990 DOI: 10.1007/s12565-021-00627-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 09/02/2021] [Indexed: 01/10/2023]
Abstract
The aortic arch (AA) branching pattern variations are usually asymptomatic, but they may lead to complications during cardiovascular procedures. In this retrospective study, we aimed to analyze the frequency of anatomical variations of the AA and to develop a different approach of morphological classification based on radiological criteria. 1026 computed tomography angiography scans of adults were evaluated and the presence of left-sided (LAA) and right-sided (RAA) AA were determined in 1023 (99.71%) and 3 (0.29%) of patients, respectively. According to the number of branches, LAA branching pattern of each patient was subclassifed in five morphological types. Based on the order and type-specific reference points, an anomalous LAA variants were classified into 20 subtypes. Type 1 (Typical branching pattern) LAA was identifed in 781 (76.12%) of the patients. Among 242 aberrant LAA variants (four types, 23.58%), the most common subtypes; Type 2A with brachiocephalico-carotid trunk (BCT), Type 4A1 with an aberrant left vertebral artery (ALVA), and Type 3A1, in which BCT coexisted with ALVA, were observed in 17.6%, 3.6%, and 0.88% of the cases, respectively. The frequency of remaining LAA variants ranged from 0.39% to 0.097%. In addition, Type 3B2 and Type 4C were first identified in our study. We observed Type I and II RAA in one female (0.097%) and two cases (male and female, 0.19%), respectively. Knowledge of AA branching variations is of great interest in neck and thoracic surgery and the new morphological types in clinically applicable form recommended in this study can be used in endovascular interventions.
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Affiliation(s)
- Gülay Açar
- Department of Anatomy, Meram Faculty of Medicine, Necmettin Erbakan University, Yunus Emre Mh. Unzile Sk, 42090, Meram, Konya, Turkey.
| | - Aynur Emine Çiçekcibaşı
- Department of Anatomy, Meram Faculty of Medicine, Necmettin Erbakan University, Yunus Emre Mh. Unzile Sk, 42090, Meram, Konya, Turkey
| | - Emine Uysal
- Department of Radiology, Faculty of Medicine, Selcuk University, 42075, Selçuklu, Konya, Turkey
| | - Mustafa Koplay
- Department of Radiology, Faculty of Medicine, Selcuk University, 42075, Selçuklu, Konya, Turkey
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Marrocco-Trischitta MM, Alaidroos M, Romarowski RM, Milani V, Ambrogi F, Secchi F, Glauber M, Nano G. Aortic arch variant with a common origin of the innominate and left carotid artery as a determinant of thoracic aortic disease: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2021; 57:422-427. [PMID: 31620770 DOI: 10.1093/ejcts/ezz277] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/29/2019] [Accepted: 09/16/2019] [Indexed: 12/15/2022] Open
Abstract
The aim of this study was to investigate whether the 'bovine' arch [i.e. arch variant with a common origin of the innominate and left carotid artery (CILCA)] is associated with an increased risk of thoracic aortic disease (TAD). The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed, EMBASE and Cochrane databases were searched to identify all case series reporting about CILCA arch and TAD between January 2008 and December 2018. A total of 485 studies were screened. The prevalence of CILCA arch was assessed, and data analysis was performed considering the difference in the risk of TAD for presence versus absence of CILCA arch. Eight studies enrolling 11 381 subjects were retrieved for quantitative analysis. The proportion of TAD among CILCA arch patients was higher [41.5% (28.1-56.4)] than the proportion among patients with standard arch configuration 34.0% (20.1-51.4). The odds ratio of developing TAD was 1.4 times higher in subjects with CILCA arch (95% confidence interval 1.068-1.839). The test for an overall effect indicated a significant association between CILCA arch and TAD (P < 0.015). The I2 was 78.1% with a value of P < 0.001 for heterogeneity. The Egger test did not show evidence of publication bias (P = 0.317). In conclusion, our meta-analysis supports the hypothesis of a correlation between the presence of CILCA arch and the onset of TAD. Our results warrant a specific and long-term surveillance for patients with this anatomical variant, and a thorough awareness of its potential clinical implications during image interpretation.
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Affiliation(s)
- Massimiliano M Marrocco-Trischitta
- Clinical Research Unit, Cardiovascular Department, IRCCS - Policlinico San Donato, Milan, Italy.,Vascular Surgery Unit, Cardiovascular Department, IRCCS - Policlinico San Donato, Milan, Italy
| | - Moad Alaidroos
- Clinical Research Unit, Cardiovascular Department, IRCCS - Policlinico San Donato, Milan, Italy.,Vascular Surgery Unit, Policlinico San Marco, Zingonia, Italy
| | - Rodrigo M Romarowski
- 3D and Computer Simulation Laboratory, IRCCS - Policlinico San Donato, Milan, Italy
| | - Valentina Milani
- Biostatistics Service, IRCCS - Policlinico San Donato, Milan, Italy
| | - Federico Ambrogi
- Biostatistics Service, IRCCS - Policlinico San Donato, Milan, Italy
| | - Francesco Secchi
- Division of Radiology, IRCCS - Policlinico San Donato, Milan, Italy
| | - Mattia Glauber
- Minimally Invasive Cardiac Surgery Department, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Giovanni Nano
- Vascular Surgery Unit, Cardiovascular Department, IRCCS - Policlinico San Donato, Milan, Italy.,Department of "Scienze Biomediche per la Salute", University of Milan, Milan, Italy
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12
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Modares M, Hanneman K, Ouzounian M, Chung J, Nguyen ET. Computed Tomography Angiography Assessment of Acute Aortic Syndromes: Classification, Differentiating Imaging Features, and Imaging Interpretation Pitfalls. Can Assoc Radiol J 2021; 73:228-239. [PMID: 33874779 DOI: 10.1177/08465371211001525] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
An acute aortic syndrome (AAS) is an important life-threatening condition that requires early detection and management. Acute intramural hematoma (IMH), aortic dissection (AD) and penetrating atherosclerotic ulcer (PAU) are included in AAS. ADs can be classified using the well-known Stanford or DeBakey classification systems. However, these classification systems omit description of arch dissections, anatomic variants, and morphologic features that impact outcome. The Society for Vascular Surgery and Society of Thoracic Surgeons (SVS-STS) have recently introduced a classification system that classifies ADs according to the location of the entry tear (primary intimomedial tear, PIT) and the proximal and distal extent of involvement, but does not include description of all morphologic features that may have diagnostic and prognostic significance. This review describes these classification systems for ADs and other AAS entities as well as their limitations. Typical computed tomography angiography (CTA) imaging appearance and differentiating features of ADs, limited intimal tears (LITs), IMHs, intramural blood pools (IBPs), ulcer-like projections (ULPs), and PAUs will be discussed. Furthermore, this review highlights common imaging interpretation pitfalls, what should be included in a comprehensive CTA report, and provides a brief overview of current management options.
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Affiliation(s)
- Mana Modares
- Faculty of Medicine, 1 King's College Circle, Medical Sciences Building, 7938University of Toronto, Toronto, Ontario, Canada
| | - Kate Hanneman
- Department of Medical Imaging, Joint Department of Medical Imaging, Peter Munk Cardiac Center, Toronto General Hospital, University Avenue, Toronto, Ontario, Canada
| | - Maral Ouzounian
- Cardiovascular Division, Department of Surgery, Peter Munk Cardiac Center, Toronto General Hospital, Toronto, Ontario, Canada
| | - Jennifer Chung
- Cardiovascular Division, Department of Surgery, Peter Munk Cardiac Center, Toronto General Hospital, Toronto, Ontario, Canada
| | - Elsie T Nguyen
- Department of Medical Imaging, Joint Department of Medical Imaging, Peter Munk Cardiac Center, Toronto General Hospital, University Avenue, Toronto, Ontario, Canada
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13
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Natsis K, Piagkou M, Lazaridis N, Kalamatianos T, Chytas D, Manatakis D, Anastasopoulos N, Loukas M. A systematic classification of the left-sided aortic arch variants based on cadaveric studies' prevalence. Surg Radiol Anat 2021; 43:327-345. [PMID: 33386933 DOI: 10.1007/s00276-020-02625-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Typical branching pattern of the left-sided aortic arch consists of the brachiocephalic trunk (BCT), the left common carotid artery (LCCA) and the left subclavian artery (LSA). Variant patterns have been associated with a broad spectrum of pathologies. The meticulous knowledge of potential aortic arch variants is of utmost importance to radiologists, interventional cardiologists, vascular and thoracic surgeons. The current systematic review collects all aortic arch branching patterns and their frequency as published by various cadaveric studies, calculates prevalence taking into account the gender and the different people background, as well. All extracted variant patterns are classified into types and subtypes according to the number of emerging (major and minor) branches (1, 2, 3, 4 and 5) and to the prevalence they appear. In cases of similar prevalence, total cases were taken into consideration; otherwise the variants were classified under the title "other rare variants". METHODS A systematic online search of PubMed and Google books databases was performed only in cadaveric studies. RESULTS Twenty studies with typical (78% prevalence) and variable (22%) branching patterns were included. Types 3b, 2b, 4b, 1b and 5b had a prevalence of 81%, of 13%, of 5%, 0% and of 0%, respectively. Common variants were the brachiocephalico-carotid trunk (BCCT, 49% prevalence), the aberrant left vertebral artery (LVA, 41%) and the aberrant right subclavian artery (ARSA, 8%). LVA of aortic origin was detected in 32%, the bicarotid trunk (biCT) in 5% and the bi-BCT trunk in 3%. Thyroidea ima artery, a minor branch emerging from the aortic arch was found in 2%. Coexisted variants were detected in 4% (ARSA with a distinct RCCA and LCCA origin), in 3% (BCCT with a LVA of aortic origin), in 2% (ARSA with a biCT and a vertebrosubclavian trunk). CONCLUSION No significant gender or ethnic differences exist among the 5 branching types. The proposed classification scheme aims to become a valuable and easy to use tool in the hands of all physicians involved in diagnosis and treatment of aortic arch pathology. It could be also useful in anatomical education, as well.
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Affiliation(s)
- K Natsis
- Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, P.O. Box 300, 54124, ThessalonÃki, Greece.
| | - M Piagkou
- Department of Anatomy, Faculty of Health Sciences, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - N Lazaridis
- Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, P.O. Box 300, 54124, ThessalonÃki, Greece
| | - T Kalamatianos
- Hellenic Center for Neurosurgical Research "Petros Kokkalis", Athens, Greece
| | - D Chytas
- Medical School, European University of Cyprus, 6, Diogenous Str, 2404, Nicosia, Cyprus
| | - D Manatakis
- Department of Surgery, Konstantopouleio General Hospital, Nea Ionia, 14233, Athens, Greece
| | - N Anastasopoulos
- Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, P.O. Box 300, 54124, ThessalonÃki, Greece
| | - M Loukas
- Department of Anatomical Sciences, School of Medicine, St George's University, Saint George's, Grenada
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14
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Mertens R, Velásquez F, Mertens N, Vargas F, Torrealba I, Mariné L, Bergoeing M, Valdés F. Higher Prevalence of Bovine Aortic Arch Configuration in Patients Undergoing Blunt Isthmic Aortic Trauma Repair. Ann Vasc Surg 2019; 67:67-70. [PMID: 31678545 DOI: 10.1016/j.avsg.2019.10.080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/18/2019] [Accepted: 10/20/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The prevalence of a bovine aortic arch configuration is higher in patients treated for thoracic aortic aneurysms and type B dissection; its prevalence in aortic isthmic trauma has not been described. METHODS A case control study was performed comparing consecutive patients treated at our institution for acute isthmic aortic transection after blunt trauma between 2002 and 2019 and a control group of consecutive sex-matched individuals undergoing imaging for nonaortic disease. Imaging and clinical findings were reviewed. Subjects were divided into bovine and nonbovine groups and prevalence was compared. The length of the aortic segment between the left subclavian artery (LSA) and the next proximal great vessel was measured in the control population and a comparison was performed between bovine and nonbovine aortic arch subjects. RESULTS Thirty-three consecutive (30 male) patients were reviewed, 66 individuals (60 male) were included in the control group. A higher incidence of bovine arch in trauma patients was found: 57.6% vs. 34.8% (PÂ =Â 0.007). The median (range, mm) and mean (SD) distance between the bovine trunk and the LSA were 13Â mm (2-27) and 12.4Â mm (5.9), respectively, compared with 5Â mm (1-27) and 7.8Â mm (6.1) between the left common carotid and LSA in nonbovine aortic arches (PÂ <Â 0.005). CONCLUSION A higher incidence of bovine arch in patients reaching out for surgical treatment for traumatic isthmic aortic transection was found in our population. Clinical interpretation of this finding can lead to several alternatives. Confirmation with larger series and data on prevalence of this anatomic variation in nonsurvivors is needed to provide a better understanding of this finding.
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Affiliation(s)
- Renato Mertens
- Departamento de CirugÃa Vascular y Endovascular, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Fernando Velásquez
- Departamento de CirugÃa Vascular y Endovascular, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás Mertens
- Departamento de RadiologÃa, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Vargas
- Departamento de CirugÃa Vascular y Endovascular, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ignacio Torrealba
- Departamento de CirugÃa Vascular y Endovascular, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Leopoldo Mariné
- Departamento de CirugÃa Vascular y Endovascular, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Michel Bergoeing
- Departamento de CirugÃa Vascular y Endovascular, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Valdés
- Departamento de CirugÃa Vascular y Endovascular, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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15
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Ding H, Zhu Y, Wang H, Luo S, Liu Y, Huang W, Dong H, Xue L, Fan R, Luo J. Management of type B aortic dissection with an isolated left vertebral artery. J Vasc Surg 2019; 70:1065-1071. [PMID: 30837179 DOI: 10.1016/j.jvs.2018.11.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/25/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The objective of this study was to report our single-center experience of thoracic endovascular aortic repair (TEVAR) and concomitant procedures in patients with type B aortic dissection (TBAD) with an isolated left vertebral artery (ILVA) and the early to midterm outcomes in these patients. METHODS Between March 2011 and June 2018, there were 31 patients (27 men; median age, 55Â years; range, 31-66Â years) with TBAD and an ILVA who received TEVAR and concomitant procedures in our center. Demographics, coexisting medical conditions, imaging features, operation details, and follow-up outcomes in these patients were retrospectively collected and analyzed. RESULTS All patients received aortic stent grafts; nine patients also received chimney stents, and 10 patients received aortic arch bypasses. The technical success rate was 96.8% (30/31), with only one patient (3.2%) showing immediate type IA endoleak. One patient experienced transient neurologic deficit, and a puncture-related femoral artery pseudoaneurysm was observed in one patient; both recovered completely before their hospital discharge. There was no death in the early term. The median duration of follow-up was 33Â months (range, 2-90Â months). Reintervention for a type II endoleak by using coils to seal the origin of the left subclavian artery was performed in one (3.1%) case 72Â months postoperatively. One (3.2%) death occurred 42Â months after operation as a result of rectal cancer. No neurologic deficits, chimney stent occlusions, or bypass occlusions were observed during the follow-up period. CONCLUSIONS Our limited experience reveals that TEVAR and concomitant procedures are relatively safe and viable for treatment of TBAD with an ILVA. Further studies with larger samples of patients and longer follow-ups are needed to confirm these findings.
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Affiliation(s)
- Huanyu Ding
- Department of Cardiology, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yi Zhu
- Department of Cardiology, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Huiyong Wang
- Department of Cardiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Songyuan Luo
- Department of Cardiology, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuan Liu
- Department of Cardiology, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wenhui Huang
- Department of Cardiology, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Haojian Dong
- Department of Cardiology, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ling Xue
- Department of Cardiology, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ruixin Fan
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jianfang Luo
- Department of Cardiology, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
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16
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Shalhub S, Schäfer M, Hatsukami TS, Sweet MP, Reynolds JJ, Bolster FA, Shin SH, Reece TB, Singh N, Starnes BW, Jazaeri O. Association of variant arch anatomy with type B aortic dissection and hemodynamic mechanisms. J Vasc Surg 2018; 68:1640-1648. [PMID: 29804742 DOI: 10.1016/j.jvs.2018.03.409] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 03/08/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Congenital aortic arch variations are more common in patients with thoracic aortic disease for reasons unknown. Additionally, little is understood about their relation to type B aortic dissections (TBAD) specifically. We investigated the prevalence of variant aortic arch anatomy in patients with TBAD compared with controls. To understand the implications of how variant aortic arch anatomy may contribute to degenerative aortic disease, we compared flow hemodynamics of three variations of aortic arches using four-dimensional flow magnetic resonance imaging (4D flow MRI). METHODS Arch anatomy on computed tomography imaging was reviewed and compared between patients with TBAD and age/sex-matched controls free of aortic pathology. Arch variants were defined as follows: common origin of innominate and left common carotid artery (bovine arch), aberrant right subclavian artery, and right-sided aortic arch. Demographics, TBAD characteristics, and follow-up data were abstracted. Patients with TBAD with variant and conventional aortic arches were compared. Additionally, three matched healthy controls with conventional, bovine, and aberrant right subclavian artery arches underwent 4D flow MRI evaluation to assess if there were differences in flow patterns by arch type. Indices of regional hemodynamic wall sheer stress were compared. RESULTS Computed tomography scans of 185 patients with TBAD (mean age, 58.1 ± 12.4 years; 72.4% males; 71.4% Caucasian) and 367 controls (mean age, 62.5 ± 13.4 years; 67% males; 77.9% Caucasian) were reviewed. Variant arch anatomy was more prevalent in patients with TBAD (40.5% vs 24.5%; P < .001). In patients with TBAD, there were no differences in the mean age of presentation and descending thoracic aorta diameter among those with variant or conventional arch anatomy. Patients with TBAD with variant arch anatomy had a higher percentage of dissection related thoracic aortic repairs (54.7% vs 33.6%; P = .004) with repairs occurring predominantly in the acute phase. 4D flow MRI demonstrated a higher systolic wall shear stress along the inner curve of the bovine arch compared with the conventional aberrant right subclavian artery arches. CONCLUSIONS Variant aortic arch anatomy is significantly more prevalent in patients with TBAD. patients with TBAD with variant arch anatomy had a higher percentage of dissection-related aortic repair. Preliminary 4D flow MRI data show differences in hemodynamic flow patterns between variant and conventional arches. Studies of long-term outcomes based on arch anatomy may offer additional insight to TBAD genesis and possibly influence management decisions.
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Affiliation(s)
- Sherene Shalhub
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash.
| | - Michal Schäfer
- Department of Cardiology, Children's Hospital Colorado, Aurora, Colo
| | - Thomas S Hatsukami
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Matthew P Sweet
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Jason J Reynolds
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Ferdia A Bolster
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Susanna H Shin
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - T Brett Reece
- School of Medicine, Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Denver, Aurora, Colo
| | - Niten Singh
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Benjamin W Starnes
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Omid Jazaeri
- School of Medicine, Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Colorado Denver, Aurora, Colo
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17
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Mylonas SN, Barkans A, Ante M, Wippermann J, Böckler D, Brunkwall JS. Prevalence of Bovine Aortic Arch Variant in Patients with Aortic Dissection and its Implications in the Outcome of Patients with Acute Type B Aortic Dissection. Eur J Vasc Endovasc Surg 2018; 55:385-391. [PMID: 29338980 DOI: 10.1016/j.ejvs.2017.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 12/01/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE/BACKGROUND To investigate the prevalence of bovine arch (BA) among patients with type A and B aortic dissection, and to provide insight into the implication of this variation on the outcome of patients with acute or subacute type B aortic dissection (a/sTBAD). METHODS This retrospective cohort analysis includes patients with a/sTBAD admitted between January 2006 and December 2016. Computed tomographic angiograms (CTAs) of patients referred because of type A aortic dissection were also re-evaluated with regard to the presence of BA. As a control group, 110 oncological patients who had undergone a chest CTA for disease staging during the study period were enrolled. A total of 154 patients with a/sTBAD and 168 with type A aortic dissection were identified during the study period. RESULTS An overall prevalence of 17.6% for BA variants was revealed. The comparison between patients with aortic dissection and the control group showed no statistically significant difference in BA prevalence (17.7% vs. 17.3%; p = 1.0). No statistically significant difference in BA prevalence was observed when comparing patients with type A aortic dissection with those with type B aortic dissection (16.6% vs. 18.8%; p = .66). During a median follow-up period of 27.8 months, 30 patients died. The mortality rate among patients presenting a BA variant was 34.5%, whereas among patients without, it was 16.0% (p = .04). Multivariate analysis revealed the presence of a BA as an independent predictor of mortality (adjusted odds ratio 3.4, 95% confidence interval 1.2-9.8). CONCLUSION The BA should be considered as a predictor of the outcome for patients with type B aortic dissection.
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Affiliation(s)
- Spyridon N Mylonas
- Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany.
| | - Arthurs Barkans
- Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany
| | - Marius Ante
- Department of Vascular and Endovascular Surgery, University of Heidelberg, Heidelberg, Germany
| | - Jens Wippermann
- Department of Cardiac and Thoracic Surgery, University of Cologne, Cologne, Germany
| | - Dietmar Böckler
- Department of Vascular and Endovascular Surgery, University of Heidelberg, Heidelberg, Germany
| | - Jan Sigge Brunkwall
- Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany
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18
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İnanç Y, İnanç Y, Ay H. The effect of demographic features on aortic arch anatomy and its role in the etiology of cerebrovascular disease. Neuropsychiatr Dis Treat 2018; 14:29-35. [PMID: 29302189 PMCID: PMC5741983 DOI: 10.2147/ndt.s152194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aim of this study was to retrospectively evaluate the distribution of aortic arches, the relationship with demographic characteristics, and the results of carotid and vertebral artery stenting procedures in patients diagnosed with cerebrovascular disease through the intra-arterial digital subtraction angiography (DSA) technique. METHODS A retrospective examination was performed on 288 patients diagnosed with cerebrovascular disease, who underwent DSA in the Department of Neurology of Gaziantep University Medical Faculty and Kahramanmaraş¸ Sütçü Imam University Medical Faculty. The patients were examined in respect of demographic features and aortic arch anatomic structure characteristics. All demographic characteristics, DSA, carotid, and vertebral artery stent results were recorded. RESULTS The patients comprised 60.1% males and 39.9% females with a mean age of 58.25 years. Type 2 aortic arch was found in 175 (60.7%) patients, Type 2 aortic arch in 99 (34.3%) patients, and Type 3 aortic arch in 14 (4.8%) patients. The right carotid artery stenosis rate was found to be higher in patients with Type 2 aortic arch (P=0.013). When the patients were evaluated according to the presence of a bovine arch, there was no significant difference in terms of age, carotid, and vertebral artery lesions (P>0.05). CONCLUSION The aortic arch and its branching properties were not found to have a direct effect on increased risk of cerebrovascular disease or stenting rates. This study can be considered to raise awareness for new studies to demonstrate the effect of aortic arch anatomic differences on cerebrovascular diseases.
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Affiliation(s)
- Yılmaz İnanç
- Department of Neurology, Faculty of Medicine, KahramanmaraÅŸ Sutcu Imam University, KahramanmaraÅŸ
| | - Yusuf İnanç
- Department of Neurology, Faculty of Medicine, Gaziantep University, Gaziantep
| | - Halil Ay
- Department of Neurology, Faculty of Medicine, Harran University, Harran, Turkey
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19
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Popieluszko P, Henry BM, Sanna B, Hsieh WC, Saganiak K, Pękala PA, Walocha JA, Tomaszewski KA. A systematic review and meta-analysis of variations in branching patterns of the adult aortic arch. J Vasc Surg 2017; 68:298-306.e10. [PMID: 28865978 DOI: 10.1016/j.jvs.2017.06.097] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 06/16/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aortic arch (AA) is the main conduit of the left side of the heart, providing a blood supply to the head, neck, and upper limbs. As it travels through the thorax, the pattern in which it gives off the branches to supply these structures can vary. Variations of these branching patterns have been studied; however, a study providing a comprehensive incidence of these variations has not yet been conducted. The objective of this study was to perform a meta-analysis of all the studies that report prevalence data on AA variants and to provide incidence data on the most common variants. METHODS A systematic search of online databases including PubMed, Embase, Scopus, ScienceDirect, Web of Science, SciELO, BIOSIS, and CNKI was performed for literature describing incidence of AA variations in adults. Studies including prevalence data on adult patients or cadavers were collected and their data analyzed. RESULTS A total of 51 articles were included (NÂ = 23,882 arches). Seven of the most common variants were analyzed. The most common variants found included the classic branching pattern, defined as a brachiocephalic trunk, a left common carotid, and a left subclavian artery (80.9%); the bovine arch variant (13.6%); and the left vertebral artery variant (2.8%). Compared by geographic data, bovine arch variants were noted to have a prevalence as high as 26.8% in African populations. CONCLUSIONS Although patients who have an AA variant are often asymptomatic, they compose a significant portion of the population of patients and pose a greater risk of hemorrhage and ischemia during surgery in the thorax. Because of the possibility of encountering such variants, it is prudent for surgeons to consider potential variations in planning procedures, especially of an endovascular nature, in the thorax.
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Affiliation(s)
- Patrick Popieluszko
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Brandon Michael Henry
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
| | - Beatrice Sanna
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Faculty of Medicine and Surgery, University of Cagliari, Sardinia, Italy
| | - Wan Chin Hsieh
- International Evidence-Based Anatomy Working Group, Krakow, Poland; First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Karolina Saganiak
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Przemysław A Pękala
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Jerzy A Walocha
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof A Tomaszewski
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
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20
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Clerici G, Giulietti E, Babucci G, Chaoui R. Bovine aortic arch: clinical significance and hemodynamic evaluation. J Matern Fetal Neonatal Med 2017; 31:2381-2387. [DOI: 10.1080/14767058.2017.1342807] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Graziano Clerici
- Centre of Reproductive and Perinatal Medicine, Santa Maria della Misericordia University Hospital, Perugia, Italy
| | - Eleonora Giulietti
- Department of Obstetrics/Gynecology, Santa Maria della Misericordia University Hospital, Perugia, Italy
| | - Giulia Babucci
- Department of Obstetrics/Gynecology, Santa Maria della Misericordia University Hospital, Perugia, Italy
| | - Rabih Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
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21
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Zhang J, Guileyardo JM, Roberts WC. Frequency and potential consequences of origin of the left vertebral artery (or the arteria thryoidea ima) directly from the aortic arch. Proc (Bayl Univ Med Cent) 2016; 29:424-425. [PMID: 27695186 DOI: 10.1080/08998280.2016.11929498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Described herein are findings in a 58-year-old man in whom necropsy disclosed origin of the left vertebral artery (or the arteria thryoidea ima) directly from the aortic arch. No functional consequences resulted. Study of previous publications disclosed the frequency of this anomaly in adults to be approximately 3.5%. Dissection has been reported to be more frequent in the left vertebral artery when it arises directly from the aorta than when it arises from the left subclavian artery.
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Affiliation(s)
- Junlin Zhang
- Baylor Heart and Vascular Institute (Zhang, Roberts) and the Departments of Pathology (Guileyardo, Roberts) and Internal Medicine, Division of Cardiology (Roberts), Baylor University Medical Center at Dallas, Texas. Dr. Zhang is now with the Department of Physical Therapy, Arkansas State University
| | - Joseph M Guileyardo
- Baylor Heart and Vascular Institute (Zhang, Roberts) and the Departments of Pathology (Guileyardo, Roberts) and Internal Medicine, Division of Cardiology (Roberts), Baylor University Medical Center at Dallas, Texas. Dr. Zhang is now with the Department of Physical Therapy, Arkansas State University
| | - William C Roberts
- Baylor Heart and Vascular Institute (Zhang, Roberts) and the Departments of Pathology (Guileyardo, Roberts) and Internal Medicine, Division of Cardiology (Roberts), Baylor University Medical Center at Dallas, Texas. Dr. Zhang is now with the Department of Physical Therapy, Arkansas State University
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22
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Zhang L, Tian W, Feng R, Song C, Zhao Z, Bao J, Liu A, Su D, Zhou J, Jing Z. Prognostic Impact of Blood Pressure Variability on Aortic Dissection Patients After Endovascular Therapy. Medicine (Baltimore) 2015; 94:e1591. [PMID: 26402822 PMCID: PMC4635762 DOI: 10.1097/md.0000000000001591] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Hypertension has been deemed as a pivotal risk factor for the development of aortic dissection; however, the importance and prognostic significance of blood pressure variability (BPV) in aortic dissection are always ignored. A total of 173 acute type B aortic dissection patients were enrolled in and retrospectively reviewed between January 2009 and November 2013. There were 74 patients with high BPV and 99 with low BPV stratified by preoperative mean BPV. Technical success was achieved in all patients. The proportions of hypertension and general anesthesia were significantly higher in the high BPV group (70.3% vs 55.6% and 77% vs 62.6%, P = 0.049 and 0.043, respectively). The risk of aorta-related death in the high BPV group was apparently higher than the low BPV group (28.4% vs 9.1%, P = 0.001). By performing multivariable logistic regression, we found history of hypertension was likely to be a risk factor of BPV (95% confidence interval [CI]: 1.010-3.911), and high BPV was an independent predictor of aorta-related death (95% CI: 1.671-9.587). The difference of aorta-related mortality was pronounced between high and low BPV subgroups regardless of the refractory hypertension (41.4% vs 14.3% and 20.0% vs 7.0%, P = 0.023 and 0.037, respectively). The thrombosis ratio of false lumen was significantly higher in the low BPV group at 3-month (72.4 ± 17.5% vs 51.8 ± 11.6%, P < 0.001) and 6-month (86.4 ± 9.1% vs 69.7 ± 7.9%, P < 0.001). High BPV is an independent risk factor for the prognosis of aortic dissection. Further studies on BPV might provide new preventive and therapeutic strategies for aortic dissection.
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Affiliation(s)
- Lei Zhang
- From the Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China (LZ, WT, RF, CS, ZZ, JB, ZJ); Department of Pharmacology, Second Military Medical University, Shanghai, China (AL, DS); and Department of Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China (JZ)
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Yeh TY, Chen CY, Huang JW, Chiu CC, Lai WT, Huang YB. Epidemiology and Medication Utilization Pattern of Aortic Dissection in Taiwan: A Population-Based Study. Medicine (Baltimore) 2015; 94:e1522. [PMID: 26356726 PMCID: PMC4616631 DOI: 10.1097/md.0000000000001522] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Acute aortic dissection (AD) is a catastrophic condition associated with a high rate of mortality. However, current epidemiological information regarding AD remains sparse. The objective of the present study was to investigate the current epidemiological profile and medication utilization patterns associated with aortic dissection in Taiwan.In this population-based study, we identified cases of AD diagnosed during 2005 to 2012 in the complete Taiwan National Health Insurance (NHI) Research Database. Patients with AD were identified using the International Classification of Disease, Ninth Revision (ICD-9) code 441.0, and surgical interventions were defined using NHI procedure codes.A total of 9092 individuals with a mean age of 64.4 ± 15.1 years were identified. The cases were divided into 3 groups: Group A included 2340 patients (25.74%) treated surgically for type A AD; Group B included 1144 patients (12.58%) treated surgically for type B AD, and Group C included 5608 patients (61.68%) with any type of AD treated with medical therapy only. The average annual incidence of AD was 5.6 per 100,000 persons, and the average prevalence was 19.9 per 100,000 persons. Hypertension was the most common risk factor, followed by coronary artery disease and chronic obstructive pulmonary disease. Within 1 year of AD diagnosis, 92% of patients were taking antihypertensive medication. Calcium channel blockers were the most frequently prescribed antihypertensive medication for long-term observation in Taiwan.The annual trends revealed statistically significant increases in the numbers and percentages of prevalence, incidence, and mortality. Changes in patients' drug utilization in patterns were observed after AD diagnosis. Our study provides a local profile that supports further in-depth analyses in AD-affected populations.
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Affiliation(s)
- Ting-Yu Yeh
- From the School of Pharmacy, Master Program in Clinical Pharmacy, Kaohsiung Medical University (TYY, CYC, YBH); Department of Pharmacy, Kaohsiung Medical University Hospital (CYC, YBH); Department of Surgery, Division of Cardiovascular surgery (JWH, CCC); and Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, R.O.C (WTL)
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