Complex endovascular repair of type B aortic dissection and predicting left arm ischemia: a case report

Thoracic endovascular aortic repair (TEVAR) is the gold standard for surgical management of descending thoracic aortic pathology. Depending on the anatomy, TEVAR often requires deployment across the origin of the left subclavian artery (LSA) to obtain a proximal seal, thus potentially compromising p...

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Bibliographic Details
Published in:Journal of medical case reports 2021-04, Vol.15 (1), p.168-168, Article 168
Main Authors: Kim, Kevin G, Grieff, Anthony N, Rahimi, Saum
Format: Article
Language:English
Subjects:
Aneurysm, Dissecting - diagnostic imaging
Aneurysm, Dissecting - surgery
Aneurysms
Aortic Aneurysm, Thoracic - diagnostic imaging
Aortic Aneurysm, Thoracic - surgery
Aortic aneurysms
Aortic Diseases - surgery
Aortic dissection
Arm
Blood Vessel Prosthesis Implantation
Carotid arteries
Case Report
Case reports
Coronary vessels
Embolization
Endovascular Procedures
Heart surgery
Humans
Ischemia
Medical imaging
Middle Aged
Ostomy
Pain
Pathology
Patients
Retrospective Studies
Spinal cord
Stents
Subclavian Artery - diagnostic imaging
Subclavian Artery - surgery
Subclavian artery coverage
Surgery
Systematic review
TEVAR
Thoracic aortic aneurysm
Treatment Outcome
Type B dissection
Vascular surgery
Veins & arteries
Zone 2 coverage
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Description
Summary:Thoracic endovascular aortic repair (TEVAR) is the gold standard for surgical management of descending thoracic aortic pathology. Depending on the anatomy, TEVAR often requires deployment across the origin of the left subclavian artery (LSA) to obtain a proximal seal, thus potentially compromising perfusion to the left upper extremity (LUE). However, in most patients this is generally well tolerated without revascularization due to collateralization from the left vertebral artery (LVA). We present a complex 59-year-old Caucasian patient case of TEVAR with a history of prior arch debranching and intraoperative LSA coverage requiring subsequent LSA embolization and emergency take-back for left carotid-subclavian bypass. The purpose of this case report is to highlight an often overlooked anatomic LVA variant and an atypical, delayed presentation of acute LUE limb ischemia.
ISSN:1752-1947
1752-1947
DOI:10.1186/s13256-021-02772-y