Total Aortic Arch Replacement in Patients With Arch Vessel Anomalies

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Total Aortic Arch Replacement in Patients With Arch Vessel Anomalies Kazuchika Suzuki, MD, PhD, Teruhisa Kazui, MD, PhD, Abul Hasan Muhammad Bashar, MBBS, PhD, Katsushi Yamashita, MD, PhD, Hitoshi Terada, MD, PhD, Naoki Washiyama, MD, PhD, Takayasu Suzuki, MD The Annals of Thoracic Surgery Volume 81, Issue 6, Pages 2079-2083 (June 2006) DOI: 10.1016/j.athoracsur.2005.12.062 Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Common brachiocephalic trunk (CBT); left common carotid artery (LCCA) and innominate artery (IA) originate from the common trunk. (B) Isolated left vertebral artery (ILVA); a left vertebral artery arising directly from the aortic arch. (C) Aberrant right subclavian artery (ARSCA); a right subclavian artery arising from the proximal descending aorta as the fourth aortic arch branch and passing behind the esophagus and trachea. (D) Coexistent common brachiocephalic trunk and isolated left vertebral artery. The Annals of Thoracic Surgery 2006 81, 2079-2083DOI: (10.1016/j.athoracsur.2005.12.062) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Preoperative magnetic resonance angiogram showing the dominant isolated left vertebral artery (arrow). The Annals of Thoracic Surgery 2006 81, 2079-2083DOI: (10.1016/j.athoracsur.2005.12.062) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) The isolated left vertebral artery (ILVA) is anastomosed to the side-hole of the left subclavian artery (LSCA) graft. (B) The isolated left vertebral artery is anastomosed to the native left subclavian artery. (C) The isolated left vertebral artery and left subclavian artery are reconstructed with en-bloc technique. The Annals of Thoracic Surgery 2006 81, 2079-2083DOI: (10.1016/j.athoracsur.2005.12.062) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 (Left) Digital subtraction angiogram with schematic after total arch replacement in a patient with aberrant right subclavian artery (ARSCA). (Right) The right subclavian artery (RSCA) was reconstructed on the right side of the trachea and esophagus. (LCCA = left common carotid artery; LSCA = left subclavian artery; RCCA = right common carotid artery.) The Annals of Thoracic Surgery 2006 81, 2079-2083DOI: (10.1016/j.athoracsur.2005.12.062) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions