Modified Total Arch Debranching TEVAR with Aberrant Left Vertebral Artery

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Interventional Cardiology

Background:

• Aortic arch aneurysms pose significant surgical challenges, particularly when associated with complex anatomy like a left aberrant vertebral artery.
• Reconstructing small, aberrant vessels within the thoracic aorta during endovascular repair is technically demanding.

Purpose of the Study:

• To describe a novel hybrid surgical approach for treating a fusiform aortic arch aneurysm in an 85-year-old patient with a left aberrant vertebral artery.
• To demonstrate the feasibility and efficacy of reconstructing the aberrant vertebral artery in the neck during thoracic endovascular repair.

Main Methods:

• A hybrid procedure combining open surgical debranching of the aortic arch with thoracic endovascular aortic repair (TEVAR).
• Reconstruction of the left aberrant vertebral artery was performed via a surgical neck approach.
• Postoperative imaging (computed tomography) was utilized to assess the repair's outcome.

Main Results:

• Successful exclusion of the aortic arch aneurysm was achieved.
• Patency of all great vessels of the aortic arch, including the reconstructed left vertebral artery, was confirmed.
• The hybrid approach provided a viable solution for complex aortic arch pathology.

Conclusions:

• This hybrid technique offers a safe and effective strategy for managing aortic arch aneurysms with challenging aberrant vertebral arteries.
• Surgical reconstruction of the aberrant vertebral artery in the neck facilitates successful TEVAR.
• This approach expands treatment options for complex aortic arch pathologies.