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Kondov S, Beyersdorf F, Braun N, Höhn R, Schlett C, Rylski B, Siepe M, Kreibich M, Gottardi R, Czerny M. Morphology of the left subclavian artery: implications for single-branched endovascular aortic arch repair. Eur J Cardiothorac Surg 2021; 61:348-354. [PMID: 34792129 DOI: 10.1093/ejcts/ezab482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 09/17/2021] [Accepted: 09/23/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Our goal was to evaluate the morphology of the aortic arch, focusing on the left subclavian artery (LSA), and to anticipate implications for single-branched endovascular aortic arch repair. METHODS We performed a morphological analysis of computed tomography angiography scans of 322 patients between January 2002 and December 2018. Arch type and distance between arch vessels on the convexity were evaluated. We defined 3 morphological types: U-type distance between the left common carotid artery (LCCA) and LSA offspring >10 mm; V-type distance between the LCCA and LSA offspring <10 mm and W-type isolated left vertebral artery offspring from the aortic arch. RESULTS Most patients presented a type III arch [50% (n = 161)]. The median distance from the brachiocephalic trunk offspring to the LCCA offspring measured 2.5 mm (2.0-3.0 mm) and that between the LCCA offspring and the LSA offspring was 6.5 mm (4.0-11.0 mm). We observed no significant difference based on the morphological type (V versus U versus W) in the brachiocephalic trunk-LCCA distance, but there were significant differences in the LCCA-LSA distance between types V and U (P < 0.001) and between types V and W (P < 0.001). Interestingly, we found no significant difference in the LCCA-LSA distance between types U and W. We noted a significant difference in the median diameter of the LSA according to U, V and W types: V type versus U type, 12.5 vs 13.5 mm (P = 0.033) as well as U type versus W type, 13.5 vs 10.5 mm (P < 0.001) and V type versus W type, 12.5 vs 10.5 mm (P < 0.002). The distances between the LSA offspring and left vertebral artery offspring between types U and V did not differ significantly. CONCLUSIONS Our categorization of the U, V and W types of the LSA can help us anticipate shapes and distances and thereby function as an initial evaluation tool for predicting single branched endovascular aortic arch repair involving the LSA.
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Affiliation(s)
- Stoyan Kondov
- Department of Cardiovascular Surgery, Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Nora Braun
- Department of Cardiovascular Surgery, Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Rene Höhn
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany.,Department of Pediatric Cardiology, University Heart Center Freiburg-Bad, Krozingen, Germany
| | - Christopher Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Maximilian Kreibich
- Department of Cardiovascular Surgery, Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Roman Gottardi
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Private Medical University Salzburg, Salzburg, Austria.,Department of Cardiac, Thoracic and Vascular Surgery, Mediclin Heart Institute, Lahr/Baden, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
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Wojnarski CM, Hughes GC. Commentary: Go "all in" the way they do in Texas-Or wait to see how the hand plays out? Extent of distal repair for acute type I dissection. J Thorac Cardiovasc Surg 2019; 158:1283-1284. [PMID: 30846268 DOI: 10.1016/j.jtcvs.2019.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Charles M Wojnarski
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Duke University, Durham, NC.
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Duke University, Durham, NC
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