Emergent left upper extremity revascularization following stent-grafting of the descending thoracic aorta in a patient w
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Hellenic Journal of Surgery (2014) 86:2, 102-105
Emergent Left Upper Extremity Revascularization Following Stent-Grafting of the Descending Thoracic Aorta in a Patient with an Aberrant Left Vertebral Artery D. Tassopoulos, B. Anagnostakou, Th. Kratimenos, D. Exarchos, A. Lioulias, X. Xaritos, I. Kokotsakis
Abstract Aim-Background: The indication for performing a left carotid-subclavian bypass in the case of an occluded left
subclavian artery following endovascular stent placement in the descending thoracic aorta is not well established. Case report: We describe a case report of a 72-year-old patient with a ruptured aortic isthmus and an aberrant left vertebral artery originating from the aortic arch, who was treated with emergent endovascular stent-graft placement in the descending thoracic aorta.In the immediate postoperative period, the patient complained of left upper extremity pain and loss of sensation, and the limb was pale . Arterial Doppler ultrasonography of the left extremity revealed monophasic arterial pulse waves associated with low flow velocities. The patient was taken to the operating room and was submitted to a left carotidsubclavian bypass using an 8mm PTFE graft. Conclusion: In the present case immediate revascularization using a carotid-subclavian bypass is strongly indicated to relieve left upper extremity ischaemia due to the absence of collateral circulation from the vertebral artery Keys words: LSA (left subclavian artery), CTA (Computerized tomographic angiograph), carotid-subclavian bypass, TEVAR, pseudoaneurysm, aberrant left vertebral artery, LZ (landing zone), LIMA (left internal mammary artery), CABG (coronary artery bypass graft)
Case report Written informed consent was obtained from the patient for publication of his personal medical data. A 72-year-old patient was admitted to our clinic on an emergency basis following blunt thoracic trauma. Computerized tomographic angiography (CTA) revealed a ruptured aortic isthmus with pseudoaneurysm formation distal to the origin of the left subclavian artery (LSA), Figure 1, as well as an aberrant left vertebral artery originating between the left common carotid and the LSA. The patient was managed with endovascular stent-graft placement (TEVAR) in the descending thoracic aorta, covering the origin of LSA. In the immediate postoperative period, the patient complained of left upper extremity pain and loss of sensation, and the limb was pale [1-3]. Arterial Doppler ultrasonography of the left extremity revealed monophasic arterial pulse waves associated with low flow
D. Tassopoulos, B. Anagnostakou, Th. Kratimenos, D. Exarchos, A. Lioulias, X. Xaritos,I. Kokotsakis Department of Cardiac Surgery, "Evagelismos" Hospital. Athens - Greece Corresponding author: D. Tassopoulos E-mail: [email protected] Received 17 Oct 2013; Accepted 21 Dec 2013
Hellenic Journal of Surgery 86
velocities. The patient was taken to the operating room and was submitted to a left carotid-subclavian bypass using an 8mm PTFE graft [3,4]. The patient’s postoperative
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