Translocation of the Isolated Left Vertebral Artery during Thoracic Endovascular Stent-Graft Repair
- VernacularTitle:左椎骨動脈の弓部大動脈直接起始例における胸部大動脈ステントグラフト治療の3症例：対麻痺予防策
- Author:
Takeshi ARAI
1
;
Daichi TAKAGI
1
;
Takuya WADA
1
;
Itaru IGARASHI
1
;
Yuya YAMAZAKI
1
;
Wataru IGARASHI
1
;
Takayuki KADOHAMA
1
;
Hiroshi YAMAMOTO
1
Author Information
- Keywords: isolated left vertebral artery; thoracic endovascular aneurysm repair; spinal cord injury
- From:Japanese Journal of Cardiovascular Surgery 2022;51(4):240-244
- CountryJapan
- Language:Japanese
- Abstract: Spinal cord injury (SCI) is a main concern in patients who undergo thoracic endovascular therapy (TEVAR), because the blood flow of the vertebro-basilar artery may be reduced due to the left subclavian artery (LSA) occlusion. If the left vertebral artery originates directly from the aorta, which is called the isolated left vertebral artery (ILVA), a technical consideration for strategies regarding blood perfusion of the ILVA during TEVARs is required. We hereby aim to report three patients (No.1, No.2, and No.3) who underwent an ILVA translocation and TEVAR with Zone 2 landing for aortic dissection. The diameter of the ILVA was 4.2, 2.3, and 2.2 mm, respectively, and the right vertebral artery (RVA) was dominant in all cases. In Patient No.1 and No.2 (ILVA diameter: 4.2 and 2.3 mm, respectively), the ILVA was anastomosed directly to the left common carotid artery. In Patient No.2, the translocated ILVA was occluded resulting in SCI, but the SCI improved when blood pressure was augmented. In Patient No.3 (ILVA diameter: 2.2 mm), the saphenous vein graft was interposed between the ILVA and the bypass artery because the ILVA diameter was small, but postoperatively, the ILVA remained patent, and no paraplegia was observed. The occlusion of ILVA could cause SCI, even if the RVA is larger than the LVA. Reconstruction of the ILVA is a critical procedure to prevent postoperative SCIs in patients undergoing TEVARs.
