Vascular Surgery, Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy.
Cardiac Surgery-Sacco University Teaching Hospital, Milan, Italy.
J Thorac Cardiovasc Surg. 2020 Jun;159(6):2189-2198.e1. doi: 10.1016/j.jtcvs.2019.06.011. Epub 2019 Jun 15.
The aim of this study was to present our experience with the management of isolated left vertebral artery during hybrid aortic arch repairs with thoracic endovascular aortic repair completion.
This is a single-center, observational, cohort study. Between January 2007 and December 2018, 9 patients (4.5%) of 200 who underwent thoracic endovascular aortic repair were identified with isolated left vertebral artery. The isolated left vertebral artery was the dominant vertebral artery in 4 cases and entered the Circle of Willis to form the basilar artery in all cases. Isolated left vertebral artery transposition was performed in 2 patients during open ascending/arch repair before thoracic endovascular aortic repair completion. In 4 patients, isolated left vertebral artery transposition was performed concomitant with carotid-subclavian bypass during thoracic endovascular aortic repair completion ("zone 2" thoracic endovascular aortic repair). Primary outcomes were early (<30 days) and late survival, freedom from aortic-related mortality, and isolated left vertebral artery patency.
Primary technical success was achieved in all cases. Isolated left vertebral artery-related complication occurred in 1 patient (Horner syndrome). Immediate thrombosis, vagus/recurrent laryngeal nerve palsy, lymphocele, and chylothorax were never observed. Postoperative cerebrovascular accident or spinal cord injury was not observed. Median follow-up was 15 months (range, 3-72). We did not observe aortic-related mortality during the follow-up. Aortic-related intervention was never required. Both isolated left vertebral artery and carotid-subclavian bypass are still patent in all patients with no sign of anastomotic pseudoaneurysm or stenosis.
Although isolated left vertebral artery is not a frequent occurrence, it is not so rare. It may pose additional difficulties during hybrid aortic arch surgical repairs, but isolated left vertebral artery transposition was feasible, safe, and a durable reconstruction.
本研究旨在介绍我们在杂交主动脉弓修复中完成胸主动脉腔内修复术后处理孤立左椎动脉的经验。
这是一项单中心、观察性、队列研究。2007 年 1 月至 2018 年 12 月，200 例接受胸主动脉腔内修复术的患者中发现 9 例（4.5%）存在孤立左椎动脉。4 例孤立左椎动脉为优势椎动脉，所有病例均进入 Willis 环形成基底动脉。在完成胸主动脉腔内修复术之前，2 例在开放升主动脉/弓部修复术中进行了孤立左椎动脉转位。在 4 例患者中，在完成胸主动脉腔内修复术时同期进行了孤立左椎动脉转位和颈动脉-锁骨下旁路手术（“区域 2”胸主动脉腔内修复术）。主要结局为早期（<30 天）和晚期生存率、免于主动脉相关死亡率以及孤立左椎动脉通畅率。
所有病例均达到了主要技术成功。1 例患者发生孤立左椎动脉相关并发症（霍纳综合征）。未观察到孤立左椎动脉即刻血栓形成、迷走神经/喉返神经麻痹、淋巴囊肿和乳糜胸。术后未发生脑血管意外或脊髓损伤。中位随访时间为 15 个月（范围 3-72 个月）。随访期间未观察到主动脉相关死亡率。未行主动脉相关介入治疗。所有患者孤立左椎动脉和颈动脉-锁骨下旁路均通畅，无吻合口假性动脉瘤或狭窄迹象。
尽管孤立左椎动脉并不常见，但也并非罕见。它可能在杂交主动脉弓外科修复中增加额外的难度，但孤立左椎动脉转位是可行的、安全的、持久的重建。
