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Aortic arch branches

Ryan C Shelstad, Justin G Reeves, Katsuhiro Yamanaka, T Brett Reece
We review the operative techniques of aortic arch replacement. Aortic arch replacement presents several formidable challenges, as it requires arresting the circulation to the body and replacement of the brachiocephalic vessels with special consideration for protecting the central nervous system. Perfusion strategies, selective antegrade cerebral perfusion, and operative graft selection are key elements in aortic arch replacement surgery. Standard approaches include the island technique, the branched graft technique, and the "Spielvogel" trifurcated graft technique-each having its own advantages...
October 7, 2016: Seminars in Cardiothoracic and Vascular Anesthesia
Yuji Kanaoka, Takao Ohki, Koji Maeda, Takeshi Baba
PURPOSE: To evaluate risk factors for early (<30 days) type I endoleak following thoracic endovascular aortic repair (TEVAR). METHODS: A retrospective study was conducted of 439 consecutive patients (mean age 74.0±10.0 years; 333 men) who underwent TEVAR at a single center between June 2006 and June 2013. Pathologies included 237 aortic arch aneurysms and 202 descending thoracic aortic aneurysms (dTAA). Maximum TAA diameter was 63.6±13.7 mm. Among the distal aortic arch aneurysms, 124 required coverage of the left subclavian artery (LSA), while the remaining 113 arch aneurysms had debranching (n=40), the chimney technique (n=52), and a branched stent-graft (n=13)...
October 19, 2016: Journal of Endovascular Therapy
Shuhua Li, Yunyun Li, Min Bai, Chuanchen Zhang
BACKGROUND The aim of this study was to investigate duplication of the vertebral artery (VA) using three-dimensional time-of-flight (3D TOF) magnetic resonance angiography (MRA) in a large study population to further our understanding of vascular variations. MATERIAL AND METHODS A retrospective analysis of 3D TOF-MRA data in 12 826 cases was performed. The occurrence rate of VA duplication was calculated and accompanied vascular anomalies were recoded. RESULTS Twenty-one VA duplication patients were found, with an occurrence rate of 0...
October 17, 2016: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Heike Huempfner-Hierl, Thomas Hierl, Dirk Halama
Tracheostomy is a common procedure in head and neck surgery and emergency medicine to secure a patent airway. Surgeons should always be aware of anatomical variants of the branches of the aortic arch, which could lead to life-threatening complications. Open tracheostomy is the safest emergency procedure.
October 4, 2016: British Journal of Oral & Maxillofacial Surgery
Junlin Zhang, Joseph M Guileyardo, William C Roberts
We describe an aortic arch anomaly consisting of the origin of the left subclavian artery as the fourth branch and the right subclavian artery as the first branch off the aortic arch with crisscrossing of these two arteries anterior to the trachea without clinical consequences. This anomaly, to our knowledge, has not been reported previously.
October 2016: Proceedings of the Baylor University Medical Center
Sharon L Cheatham, Grace M Deyo
Hybrid stage I palliation combines cardiothoracic surgery and interventional transcatheter procedures for treatment of hypoplastic left heart syndrome. The approach is an alternative to the Norwood procedure, the traditional first stage of surgical palliation. Hybrid stage I palliation involves placing bilateral branch pulmonary artery bands and a patent ductus arteriosus stent through a median sternotomy, performed without cardiopulmonary bypass. The purpose of the bands is to control blood flow to the lungs and protect the pulmonary bed while the stent sustains systemic cardiac output...
October 2016: Critical Care Nurse
Fang Huang, Qiang Chen, Qing-Quan Lai, Wen-Han Huang, Hong Wu, Wei-Cheng Li
The purpose of this study was to preoperatively evaluate the value of aortic arch lesions by multidetector computed tomography (MDCT) angiography in type A aortic dissection (AD).From January 2013 to December 2015, we enrolled 42 patients with type A AD who underwent MDCT angiography in our hospital. The institutional database of patients was retrospectively reviewed to identify MDCT angiography examinations for type A AD. Surgical corrections were conducted in all patients to confirm diagnostic accuracy.In this study, the diagnostic accuracy of MDCT angiography was 100% in all 42 patients...
September 2016: Medicine (Baltimore)
Yuji Kanaoka, Takao Ohki, Hirotsugu Ozawa
We report a case in which a stent graft and an Amplatzer® vascular plug (AVP) were effective for the treatment of chronic aneurysmal aortic dissection. The patient was a 52-year-old man. At 45 years of age, he developed acute aortic dissection, for which he underwent surgery four times with prosthetic graft replacement in the abdominal aorta, descending thoracic, ascending aorta (without neck branch reconstruction), and thoracoabdominal aorta with the reconstruction of the celiac, superior mesenteric and bilateral renal arteries...
September 23, 2016: Annals of Vascular Surgery
David Bell, David Marshman
We describe the case of a 70-year-old man with Marfan Syndrome who was found to have Diffuse Large B Cell Lymphoma (DLBCL) within an ascending aortic graft, his native aortic arch and arch vessels. Ten years previously he had undergone a Bentall's Procedure for a dilated aortic root. He presented with a left middle cerebral artery stroke. Computed tomography (CT) scan revealed multiple filling defects within the aortic arch and branch vessels suggestive of thrombus. Following the stroke, his neurological deficit improved...
August 31, 2016: Heart, Lung & Circulation
A S Suiumov
Described in the article is a case report concerning a female patient presenting with aortic valve insufficiency, lesions of the pulmonary artery, aortic arch branches, visceral and renal arteries, aneurysm of the whole aorta on the background of nonspecific aortoarteritis (NAA). Lesions of the pulmonary artery, aorta and its branches were diagnosed by means of MSCT angiography, which is the most informative method of study in this cohort of patients, making it possible to accurately diagnose both the degree of the lesion and its extent, as well as to carry out dynamic follow up of patients...
2016: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
Lei Wang, Jian Zhang, Shijie Xin
OBJECTIVE: The prevalence of various aortic arch branching patterns has not been established in Chinese people. Little is known regarding the underlying associations among age, sex, aortic arch type, branching variants, and even vertebral artery (VA) dominance (VAD) or VA hypoplasia (VAH). Thus, this study aimed to determine the prevalence of variations in aortic arch branching and types of arches in a Chinese population and to evaluate the associations among age, sex, aortic arch type, branching variants, and asymmetric VAs...
August 30, 2016: Journal of Vascular Surgery
Hélène Wattez, Teresa Martin-Gonzalez, Benjamin Lopez, Rafaëlle Spear, Rachel E Clough, Adrien Hertault, Jonathan Sobocinski, Stéphan Haulon
BACKGROUND: Endovascular repair of aortic aneurysms involving the visceral segment of the aorta often requires placement of a covered bridging stent in the celiac axis (CA). The median arcuate ligament (MAL) is a fibrous arch that unites the diaphragmatic crura on either side of the aortic hiatus. The ligament may compress and distort the celiac artery and result in difficult cannulation, or stenosis and occlusion of the vessel. This study evaluated the influence of the MAL compression on the technical success and the patency of the celiac artery after branched and fenestrated endovascular aortic repair...
August 30, 2016: Journal of Vascular Surgery
S W K Cheng
Endovascular repair has evolved to become a viable mainstream treatment for aortic pathology in both acute and elective settings. As technology advanced, traditional anatomical barriers were progressively tackled using new devices and novel procedures, and there are now multiple options available to the vascular surgeon. In the abdominal aorta, advances in endovascular aneurysm repair have been in the treatment of hostile aortic necks using new sealing concepts and ancillary procedures, and in branch preservation using fenestrations and snorkels...
September 2016: British Journal of Anaesthesia
B L Powell
A 48-year-old woman was seen in a surgical outpatient clinic with a 2 year history of progressive dysphagia with occasional regurgitation, partially controlled with a proton pump inhibitor. Primary investigations of pH testing and gastroscopy were normal, although a barium swallow study revealed significant hold-up at the aortic arch impression and a posterior right-sided oesophageal impression suggestive of a right-sided aortic arch. A follow-up computed tomography angiogram discovered a vascular ring encircling the trachea and oesophagus, formed by a right-sided aortic arch with aberrant aortic branches, and a Kommerell's diverticulum...
August 23, 2016: Annals of the Royal College of Surgeons of England
Kwangjo Cho, Jeahwa Jeong, Jongyoon Park, Sungsil Yun, Jongsu Woo
BACKGROUND: We analyzed the long-term results of ascending aortic replacement and arch aortic replacement in acute DeBakey type I aortic dissections to measure the differences in the distal aortic changes with extension of the aortic replacement. METHODS: We reviewed 142 cases of acute DeBakey type I aortic dissections (1996-2015). Seventy percent of the cases were ascending aortic replacements, and 30% of the cases underwent total arch aortic replacement, which includes the aorta from the root to the beginning of the descending aorta with the 3 arch branches...
August 2016: Korean Journal of Thoracic and Cardiovascular Surgery
Wouter W Jansen Klomp, Linda M Peelen, George J Brandon Bravo Bruinsma, Arnoud W J Van't Hof, Jan G Grandjean, Arno P Nierich
BACKGROUND: Transesophageal echocardiography (TEE) is a key diagnostic modality in patients with acute aortic dissection, yet its sensitivity is limited by a "blind-spot" caused by air in the trachea. After placement of a fluid-filled balloon in the trachea visualization of the thoracic aorta becomes possible. This method, modified TEE, has been shown to be an accurate test for the diagnosis of upper aortic atherosclerosis. In this study we discuss how we use modified TEE for the diagnosis and management of patients with (suspected) acute aortic dissection...
2016: Cardiovascular Ultrasound
Florian Stefanov, Liam Morris, Ala Elhelali, Edel P Kavanagh, Violet Lundon, Niamh Hynes, Sherif Sultan
OBJECTIVE: Aortic arch aneurysms and thoracoabdominal aortic arch aneurysms are technically challenging to manage by established surgical and endovascular methods. The Streamliner Multilayer Flow Modulator device (Cardiatis, Isnes, Brussels, Belgium) offers an unorthodox option for these high-risk cases. The Streamliner device for aortic arch repair (STAR) study investigated complex aneurysm cases managed by the Streamliner Multilayer Flow Modulator device and offers an analytic solution for a clinical dilemma...
November 2016: Journal of Thoracic and Cardiovascular Surgery
Charles P E Milne, Mau Amako, Rafaelle Spear, Rachel E Clough, Adrien Hertault, Jonathan Sobocinski, Wendy Brown, Stéphan Haulon
BACKGROUND: The development of a postdissection aortic arch aneurysm after open ascending aortic replacement for type A dissection places the patient at increased risk for an open operation due to the need for redo sternotomy and total arch replacement. We conducted a computed tomography-based feasibility study to assess what proportion of these patients would be anatomically suitable for branched endograft repair of an arch aneurysm. We also aimed to identify ways to tailor the index operation to increase suitability for future endovascular repair...
July 22, 2016: Annals of Thoracic Surgery
John W Giltner, Edward R Thomas, William K Rundell
A 68-year-old female with no significant past medical history presented with loss of vision in the lower half of her left eye that lasted <5 minutes. No abnormalities were found on ocular or physical exam. Computed tomography angiography and carotid ultrasound were performed, which confirmed the diagnosis as amaurosis fugax with two abnormalities leading to the transient retinal vessel occlusion. First, it was found that the patient has a congenital vascular anomaly, which consisted most notably of a right-sided aortic arch...
2016: International Medical Case Reports Journal
Shuyang Lu, Shouguo Yang, Hao Lai, Jiayu Zheng, Tao Hong, Xiaoning Sun, Chunsheng Wang
BACKGROUND: This study aimed to analyze the mortality and morbidity of patients undergoing open aortic arch reconstruction for acute type A aortic dissection. METHODS: Between September 2005 and January 2012, 267 consecutive patients underwent open aortic arch reconstruction for acute type A aortic dissection at our center. The mean age was 51.2 ± 10.0 years, and 200 patients were male. Sixty-three and 184 patients underwent hemiarch replacement and total arch replacement, respectively, whereas the remaining 20 patients underwent single- or triple-branched stent graft implantation...
2016: Journal of Cardiothoracic Surgery
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