Spontaneous innominate and left common carotid artery dissection with bovine aortic arch

We describe a case of a 63-year-old woman who presented with spontaneous dissection of the innominate and left common carotid arteries arising from a common trunk, so-called “bovine aortic arch.” The entry tear was seen in the common trunk at the origin of the innominate artery with no dissection extending into the aortic arch or the ascending aorta. The dissection was resected and total arch replacement was performed considering the aortic wall fragility complicated by the dissection.     

Transposition of the left carotid artery to the ascending aorta to repair aortic arch injury

Abstract   We present a case where we repaired the aortic arch, by the transposition of the left carotid artery to the ascending aorta. A 52-year-old man presented to our department with a penetrating chest wound by a gunshot in the attempt of suicide. The aortic arch and the insertion of the left carotid artery were involved in the lesion. Through sternotomic approach, the aortic arch was repaired in extracorporeal circulation. Left carotid artery was transected to allow easier repair of the arch posterior wall involved in the lesion, and to reduce the danger of residual stenosis. Then, it was translocated to the ascending aorta by interposing a 7-mm Gore-Tex (W.L. Gore & Associates, Flagstaff, AZ, USA) conduit. The patient complicated renal failure and pneumonia in the postoperative period, but eventually he was discharged in good general conditions.     

Absent left common carotid artery in a right aortic arch: Separate origins of left internal and external carotid arteries from brachiocephalic artery

We present a case of cyanotic congenital heart disease with left common carotid artery agenesis in the setting of the right aortic arch highlighting the potential implications in management.     

Combined traumatic avulsion of the aortic valve and rupture of the left common carotid artery.

A case of complete rupture of the left common carotid artery at the aortic arch and avulsion of a cusp of the aortic valve due to blunt trauma is presented. The ruptured carotid artery was reimplanted into the left subclavian artery, and the avulsed aortic valve cusp was successfully repaired by direct suturing.     

Surgical treatment for traumatic transection of left common carotid artery

I njurytothesupraaorticarteryisarareevent,withpoorprognosisandhighmortality.1Improvementoftheoutcomemaylieonthecombinationofseveralaspects,includingbetterpre hospitalcare,useofemergencycardiopulmonarybypass(CPB),improvedsurgicaltechniquesandfacilities,andadvancedpostoperativeintensivecare.Someresearchersemphasizedtheimportanceofemergency CPBinthetreatmentandthoughtthatitwas responsiblemainlyfortheimprovedoutcome.2 6 However,thereexistscontroversiesaboutit.7 9Inthis article,wereportedthatapa…     

Separate arch origin of the left external carotid artery with common trunk giving rise to the left internal carotid artery and left subclavian artery

We present a case of a 3-year-old boy with tetralogy of Fallot having the direct origin of the left external carotid artery from the aorta with a common trunk giving rise to the left internal carotid artery and left subclavian artery, in a right-sided aortic arch. We also highlight the potential implications in management.     

Castor支架在主动脉弓病变中重建左颈总动脉的可行性和有效性研究

背景与目的 胸主动脉腔内修复术（TEVAR）已成为治疗主动脉弓病变的首选方法。如何重建主动脉弓上分支,是TEVAR的难点和研究方向之一。目前,Castor单分支主动脉覆膜支架广泛应用于TEVAR术中重建左锁骨下动脉,但其应用于重建左颈总动脉（LCCA）报道少见。因此,本研究探讨TEVAR术中运用Castor单分支主动脉覆膜支架在TEVAR术中重建LCCA的可行性和有效性。方法 回顾2021年10月—2022年9月潍坊市人民医院血管外科收治的5例累及Z2区的主动脉弓病变患者资料,患者均为男性;年龄39~77岁,平均（59.2±14.08）岁,其中急性Stanford B型主动脉夹层3例,主动脉弓动脉瘤2例。所有患者均在数字减影血管造影引导下采用Castor一体化分支型主动脉覆膜支架在TEVAR术中重建LCCA。分析手术相关指标及术后不良事件发生率,以及术后随访6个月内不良事件的发生情况与主动脉重塑情况。结果 5例患者均手术成功。手术时间168~233 min,平均（191±19.06）min,无中转开胸手术。5例患者的LCCA均成功采用Castor单分支支架行血运重建。术后住院期间发生1例脑卒中,术后2个月意识清晰,右上肢肌力完全恢复（Ⅴ级）;其余4例患者住院及随访期间无全因死亡、脑卒中、支架移位、夹层复发、内漏、截瘫、左上肢缺血等并发症。患者术后6个月复查主动脉CT血管造影显示Castor单分支支架位置良好,主动脉峡部平面主动脉平均直径与肺动脉分叉平面主动脉平均直径均较术前明显减小（35.8 mm vs. 41.9 mm,P=0.035;31.1 mm vs. 36.7 mm,P=0.048）;主动脉及分支支架通畅率为100%,无内漏,瘤腔/假腔均出现血栓化。结论 在严格把握适应证的前提下,Castor单分支支架在TEVAR术中重建LCCA安全可行,然而,其疗效仍需更长时间的随访和更多的病例验证。     

The carotid artery as alternative access for endoluminal aortic aneurysm repair

Endograft treatment of aortic aneurysms has become a common procedure in many centers. However, not all patients are candidates for this new technology, because of their vascular anatomy and device limitations. One common problem is iliofemoral occlusive disease, which when present, even in a moderate degree, may preclude introduction of the large-diameter delivery devices currently in use. We present a case of a high-risk male patient with a thoracic aortic aneurysm and severe occlusive disease of the iliac arteries. An alternative approach for device delivery through the carotid artery was used and the procedure was successful with no neurologic complications. We recommend this technique for highly selected patients with an aneurysm who can undergo tube endograft repair without feasible access through the iliac or femoral arteries.     

Complications associated with clamping the aorta between the left common carotid artery and left subclavian artery

BACKGROUND: Hypothermic circulatory arrest using a left thoracotomy has recently been recommended for repair of distal arch lesions to prevent the atheroembolism that often results from clamp injury. The recommendation holds even for cases in which aortic cross-clamping between the left common carotid artery and left subclavian artery is possible. METHODS: Over the last 16 years, 69 patients underwent repair of the distal arch or descending thoracic aorta using distal perfusion with the proximal aortic clamp placed between the left common carotid and left subclavian artery. The average age of the patients was 61+/-12 years; 18 of them (26%) were older than 70 years. Forty-four patients (64%) had atherosclerotic true aneurysms. RESULTS: The surgical procedures used included patch closure of saccular aneurysms in 20 patients (29%) and graft replacement in 47 (71%). The left subclavian artery was reattached in 7 patients (10%). Although there were 3 hospital deaths (4%), no cerebral complications occurred aside from temporary neurologic dysfunction in 4 patients (6%). CONCLUSIONS: An acceptably low incidence of cerebral complications is associated with cross-clamping the aorta between the left common carotid artery and left subclavian artery.     

Cannulation of the left main pulmonary artery for partial left heart bypass.

Cannulation of the left main pulmonary artery for partial left heart bypass is described. We have employed this method successfully in 5 patients who underwent resection of aneurysms of the descending thoracic aorta. A main advantage is that high and consistent rates of venous return are obtainable.