Management of Anomalous Left Vertebral Artery During Open Total Arch Replacement
Tom X Liu1, Adwaiy Manerikar1, Daniel Won1
1Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School Medicine, Chicago, Illinois.
Annals of Thoracic Surgery Short Reports
|January 10, 2025
Summary
Anomalous left vertebral artery (aLVA) revascularization during aortic arch surgery is safe. Strategies to preserve aLVA during open total arch replacement showed no negative impact on patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Anatomical Variants
Background:
- An anomalous left vertebral artery (aLVA) presents unique challenges in aortic arch surgery.
- Revascularization strategies are crucial for managing this anatomical variation during open total arch replacement.
Purpose of the Study:
- To examine the safety and efficacy of various aLVA revascularization techniques.
- To evaluate the impact of aLVA on perioperative and long-term outcomes in patients undergoing aortic arch surgery.
Main Methods:
- Retrospective analysis of 11 patients with aLVA undergoing total arch replacement (2018-2023).
- Comparison with 31 matched controls with conventional anatomy.
- Primary outcome: perioperative stroke; Secondary outcomes: spinal cord ischemia, long-term stroke.
Main Results:
- No postoperative mortality observed in the aLVA group.
- Perioperative stroke rate was 9% in both aLVA and control groups (P=1.00).
- One-year patency for aLVA transposition was 100%.
Conclusions:
- The presence of aLVA does not adversely affect outcomes in open aortic arch surgery.
- Preserving aLVA via revascularization is a safe and feasible strategy.
- Transposition techniques offer excellent long-term patency for anomalous left vertebral artery reconstruction.
Related Concept Videos
01:10The Arch of Aorta
The coronary arteries, originating from the ascending aorta, bifurcate from two sinuses located within the ascending aorta. Positioned just above the aortic semilunar valve, these sinuses house essential aortic baroreceptors and chemoreceptors, crucial for maintaining cardiac function. The left coronary artery and the right coronary artery branch off from the left posterior and anterior aortic sinuses, respectively.
Encircling the heart, the coronary arteries form a ring-like structure before...
Encircling the heart, the coronary arteries form a ring-like structure before...
01:25Aortic Regurgitation III: Medical Management
Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
01:26Aneurysm III: Interprofessional Care
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
01:22Aneurysm IV: Nursing Management
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...