Left vertebral artery reconstruction during surgery for Stanford type A aortic dissection complicated with isolated left vertebral artery
Objective To observe the efficacy and safety of left vertebral artery reconstruction during surgery for Stanford type A aortic dissection(TAAD)complicated with isolated left vertebral artery(ILVA).Methods Twenty-six patients with TAAD complicated with ILVA underwent surgical treatment in Fuwai Central China Cardiovascular Hospital from April,2017 to October,2022,and their clinical data were retrospectively analyzed.The surgical plan,death and stent leakage during hospitalization and neurological complications were recorded.Aortic CT angiography was performed 3 months after surgery to detect left vertebral artery patency,anastomotic stenosis,aneurysm,and stent leakage.The follow-up was done till March,2023,to record aortic related deaths.Results(1)In 26 patients,24 underwent total arch replacement+stent trunk surgery under moderate hypothermia cardiopulmonary bypass,including ascending aorta replacement in 19 patients and Bentall surgery in 5;2 patients underwent ascending aorta replacement+arch debranching+endovascular aneurysm repair procedure under mild hypothermia cardiopulmonary bypass.(2)Left vertebral artery reconstruction was done according to the extent of dissection involvement and location of the tear,in which 17 patients underwent end-to-side anastomosis of ILVA and left common carotid artery,8 underwent intraoperative stent graft fenestration to reconstruct left vertebral artery and left subclavian artery,and 1 underwent end-to-side anastomosis of ILVA with left subclavian artery graft.(3)Type Ⅰ b stent leakage developed in 1 patient during hospitalization,and no surgery was done again.The false lumen near the stent showed complete thrombosis and the leakage disappeared 3 months after surgery.The other 25 patients had unobstructed left vertebral artery anastomosis and no stent leakage.No neurological complications occurred after surgery.During hospitalization,2 patients died of postoperative gastrointestinal bleeding and multiple organ failure,and the remaining 24 patients were cured and discharged.Aortic CT angiography 3 months after surgery showed that ILVA was unobstructed in all patients,with no anastomotic stenosis,aneurysm or stent leakage.The follow-up lasted averagely for(43±18)months,showing no aortic related deaths.Conclusions The individualized surgical plan should be formulated after evaluating the relationship between left vertebral artery and other surrounding vessels and the extent of dissection involvement in TAAD patients with ILVA.To reconstruct the left vertebral artery during TAAD surgery is effective and safe,and it can reduce the occurrence of perioperative neurological complications.
aortic dissectionStanford type Aisolated left vertebral arteryleft common carotid arteryleft subclavian arteryinnominate artery
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