Anomalies and Variant Anatomy of the Aorta and the Supra- aortic Vessels

Abstract

IntroductionEndovascular or hybrid approach to the aortic arch aneurysms is nowadays an appealing solution for selected patients. Aim of this retrospective study is to evaluate the technical and clinical success recorded in complex anatomical settings of endografting.MethodsBetween December 2004 and December 2008, 73 patients were treated with a stent-graft for thoracic aorta aneurysms at our Vascular and Endovascular Surgery center, or in other Italian Centers by our Vascular Surgeon as Proctor. The aortic arch was involved in 31 cases. Four cases of bovine arch, three aberrant right subclavian artery and one case of isolated origin of all the supra-aortic trunks (6 vessels) were recorded. Technical success, procedural planning time and procedural time, stroke and paraplegia incidences were analyzed in terms of difference between “normal” or “complex” arches.ResultsTechnical success was achieved in all cases. Complex anatomy of the arch and the supra-aortic trunks increased the technical difficulty of endovascular exclusion of the aneurysm and required more often complex debranching of the supra-aortic vessel necessary to obtain an adequate landing zone and to preserve the brain and spinal cord perfusion. We observed one stroke in complex arches procedures and two strokes (one of them fatal) in normal arch procedures. No cases of paraplegia were observed.ConclusionsIn our experience complex anatomy of the arch did not represent a predictive factor in term of peri-procedural major neurological adverse events.

Follow-up Results of Endovascular Aneurysm Repair Following Abdominal Visceral Debranching

“…The need for special branched or fenestrated grafts and/or hybrid procedures arise. When the aneurysm is at the vicinity of visceral arteries or if there is no safe proximal or distal landing zones, endovascular procedures may fail, and open surgery may be required [ 9 ] . In such circumstances, when open surgery carries high risks, hybrid procedures are also valid alternatives.…”

A Rare Case of an Ascending Aorta and Aortic Arch Aneurysm with an Aberrant Right Common Carotid Artery and a Proximal Descending Aortic Ectasia

“…The type of approach used should be tailored to the anatomic variables associated with the aortic anomalies. The technical challenges of stent graft deployment, such as proximity to the great vessels and arch tortuosity, have been and remain a focus of device engineering [15].…”

“…Detailed evaluation of the aortic arch anatomy is important for planning thoracic surgery and endovascular intervention since the presence and pattern of arch variants and anomalies may influence the surgical incision, cardiopulmonary bypass cannulation and interventional approach. In addition, decisions regarding whether to repair coexisting lesions in the same procedure should be considered [15,16].…”