External carotid-to-subclavian artery bypass in stent grafting of thoracic aorta

• Published in: Asian cardiovascular & thoracic annals Vol. 21; no. 5; pp. 546 - 550
• Main Authors: Shimura, Shinichiro, Yamaguchi, Masaomi, Cho, Yasunori, Aki, Akira, Furuya, Hidekazu, Ueda, Toshihiko
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.10.2013
• Subjects: Aged; Aged, 80 and over; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - physiopathology; Aorta, Thoracic - surgery; Aortography - methods; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - instrumentation; Blood Vessel Prosthesis Implantation - methods; Carotid Artery, Common - surgery; Endovascular Procedures - instrumentation; Endovascular Procedures - methods; Female; Humans; Male; Middle Aged; Polytetrafluoroethylene; Prosthesis Design; Stents; Subclavian Artery - surgery; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Vascular Patency; Vocal Cord Paralysis - etiology; blood vessel prosthesis implantation; common; stents; subclavian artery; Aorta; thoracic; carotid artery
• ISSN: 0218-4923; 1816-5370
• DOI: 10.1177/0218492312462224

Background A bypass between the left common carotid artery and the left subclavian artery has been made in some patients undergoing thoracic endovascular aortic repair that covers the orifice of the left subclavian artery. However, complications associated with temporary occlusion of the left common carotid artery are reportedly not uncommon. Methods Between January 2009 and September 2011, left external carotid-to-left subclavian artery bypass was made using a polytetrafluoroethylene graft in 15 patients undergoing a thoracic endovascular aortic repair that covered the orifice of the left subclavian artery. Adverse effects associated with the procedure were assessed, and patency of the bypass graft was determined by contrast-enhanced computed tomography before discharge and at least once during follow-up. Results All patients were discharged without any brain complications. All 15 bypass grafts were patent prior to discharge and during the follow-up period. One patient suffered temporary left recurrent laryngeal nerve palsy postoperatively. No other sequelae were associated with left external carotid-to-left subclavian artery bypass. Conclusion Left external carotid-to-left subclavian artery bypass is a promising procedure in patients undergoing thoracic endovascular aortic repair that covers the orifice of the left subclavian artery.