Arteria Lusoria Facilitates Hybrid Management of Aortic Arch Pseudoaneurysm

Simon Bejjani; Nadine Kawkabani; Rula Darwish; Omar Boustros; Moussa Abi Ghanem; Bassam Abu Khalil

doi:doi:10.11648/j.ijcts.20180403.12

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Arteria Lusoria Facilitates Hybrid Management of Aortic Arch Pseudoaneurysm

Simon Bejjani, Nadine Kawkabani, Rula Darwish, Omar Boustros, Moussa Abi Ghanem, Bassam Abu Khalil

Published in International Journal of Cardiovascular and Thoracic Surgery (Volume 4, Issue 3)

Received: 24 July 2018 Accepted: 6 August 2018 Published: 1 September 2018

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Abstract

Classic open ascending aortic replacement is an effective treatment for Stanford type A aortic dissection However it is associated with a mortality ranging between 15 to 60%. This incidence is even higher in recurrent cases. In these patients, hybrid procedures which combine thoracic endovascular aortic repair (TEVAR) with aortic arch vessel bypasses are successfully adopted. This paper reports a successful hybrid management of aortic arch pseudoaneurysm in a 66 year old female patient known to be hypertensive, diabetic,smoker dyslipidemic on dialysis and who underwent one year previously a surgical ascending aortic repair. Aortic arch vessel bypasses -necessary in this case – were facilitated by the presence of an aberrant right subclavian artery known as Arteria Lusoria- This variant, a rare embryologic anomaly of the aortic arch vessels, described by Hunauld in 1735, was used as an inflow artery to the right common carotid allowing the surgeons to avoid a left to right common carotid artery bypass known to be associated with many complications. Although the hybrid management seems a feasible and safe option especially in high risk patients not eligible for open surgical repair, furher clinical studies and development of new devices dedicated to treat ascending aortic diseases are fundamental to improve outcomes.

Published in	International Journal of Cardiovascular and Thoracic Surgery (Volume 4, Issue 3)
DOI	10.11648/j.ijcts.20180403.12
Page(s)	26-29
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2018. Published by Science Publishing Group

Keywords

Aortic Arch Pseudoaneurysm, Hybrid Management, Arteria Lusoria

References

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[2]	Roselli E, Idrees J, Greenberg ROJ, Johnston D, Lytle B. Endovascular stent grafting for ascending aorta repair in high risk patients. J thorac cardiovasc surg. 2015; 149:144-154.
[3]	Sobocinsky J O, brien N, Maural B, Bartoli M, Gourffic Y, Sassard T, Midulla M, Koussa M, Vincentelli A, Haulon S. Endovascular approaches to acute aortic type A dissection: A CT based feasability study. Eur j vasc endovasc surg. 2011; 42:442-447.
[4]	Ronchey S, Serrao E, Alberti V, Fazzini S, Trimarchi S, Tolenaar J L, Mangialardi N. Endovascular stenting of the ascending aorta for type A aortic dissections in patients at high risk for open surgery. Eur vasc and endovasc surg. 2013; 45:475-480.
[5]	Metcalfe M J, Karthikesalingam A, Black S A, LoftusI M, Morgan R, Thompson MM. The first endovascular repair of an acute type A dissection using an endograft designed for the ascending aorta. J vasc surg. 2012; 55:220-222.
[6]	Shah A, Khaynezhad A. Thoracic endovascular repair for acute type A aortic dissection: operative technique. Ann cardiothorac surg. 2016; 5 (4):389-396.
[7]	Dake M D, Thompson M, Van Sambeek M et al. Dissect: A new mnemonic-based approach for the categorization of aortic dissection. Eur J vasc endovasc surg2013; 46:175-190.
[8]	Polgui M, Chrzanowski L, KasprzakJ D, Stefanzyk L, Topol M, Majos A. The Aberrant right subclavian artery (Arteria Lusoria):The Morphological and clinical aspects of one of the most important variations-A systemic study of 141 reports. Scientific world J.2014:1-6.
[9]	Shneider J, Baier R, Dinges C, Unger F: Retroesophageal right subclavian artery (lusoria) as origin of traumatic aortic rupture. Eur J Cardio thorac surg. 2007; 32 (2):385-387.
[10]	Kirsh M, Soustelle C, HouelRHillion M L, Loisance D Risk factor analysis for proximal and distal reoperations after surgery for acute type A aortic dissection. The journal of thoracic and cardiovasc surg; 123 (2):318-325.
[11]	Kolvenbach R R, Karmel R, Pinter L S, Zhu Y, Lin F, Wassijew S et al. Endovascular management of ascending aortic pathology. J vasc surg. 2011; 53:1431-1437.
[12]	Lu Q, Feng J, Zhou J et al. Endovascular repair of ascending aortic dissection:a novel treatment option for patients judged unfit for direct surgical repair J Am coll cardiol. 2013; 61:1917-1924.
[13]	Zimpfer D, Czerny M, Kettenbach J, Shoder M, Wolner E, LammerJ et al. Treatment of acute type A dissections with aortic arch involvement. J cardiovasc surg (Torino). 2006; 47:497-502.
[14]	Ihnken K, Sze D, Dake M D, Fleischermann D, van der Srarre P, Robbins R. Successful treatment of Stanford type A dissection by placement of a covered stent graft in the ascending aorta. J thorac cardiovasc surg. 2004; 214:1808-1810.
[15]	Molz G, Burri B. Aberrant subclavian artery (Arteria Lusoria): sex differences in the prevalence of various forms of the malformation evaluation of 1378 observations virchows archive. Pathological Anatomy and Histology. 1978; 380 (4):303-315.
[16]	Nakajima Y, Nishibatake M, Ikeda K, Momma K. Takao A, TeraiM. Abnormal development of fourth aortic arch derivatives in the pathogenesis of tetralogy of Fallot. Pediatric cardiology. 1990; 11 (2):69-71.

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APA Style

Simon Bejjani, Nadine Kawkabani, Rula Darwish, Omar Boustros, Moussa Abi Ghanem, et al. (2018). Arteria Lusoria Facilitates Hybrid Management of Aortic Arch Pseudoaneurysm. International Journal of Cardiovascular and Thoracic Surgery, 4(3), 26-29. https://doi.org/10.11648/j.ijcts.20180403.12

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ACS Style

Simon Bejjani; Nadine Kawkabani; Rula Darwish; Omar Boustros; Moussa Abi Ghanem, et al. Arteria Lusoria Facilitates Hybrid Management of Aortic Arch Pseudoaneurysm. Int. J. Cardiovasc. Thorac. Surg. 2018, 4(3), 26-29. doi: 10.11648/j.ijcts.20180403.12

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AMA Style

Simon Bejjani, Nadine Kawkabani, Rula Darwish, Omar Boustros, Moussa Abi Ghanem, et al. Arteria Lusoria Facilitates Hybrid Management of Aortic Arch Pseudoaneurysm. Int J Cardiovasc Thorac Surg. 2018;4(3):26-29. doi: 10.11648/j.ijcts.20180403.12

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@article{10.11648/j.ijcts.20180403.12,
  author = {Simon Bejjani and Nadine Kawkabani and Rula Darwish and Omar Boustros and Moussa Abi Ghanem and Bassam Abu Khalil},
  title = {Arteria Lusoria Facilitates Hybrid Management of Aortic Arch Pseudoaneurysm},
  journal = {International Journal of Cardiovascular and Thoracic Surgery},
  volume = {4},
  number = {3},
  pages = {26-29},
  doi = {10.11648/j.ijcts.20180403.12},
  url = {https://doi.org/10.11648/j.ijcts.20180403.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20180403.12},
  abstract = {Classic open ascending aortic replacement is an effective treatment for Stanford type A aortic dissection However it is associated with a mortality ranging between 15 to 60%. This incidence is even higher in recurrent cases. In these patients, hybrid procedures which combine thoracic endovascular aortic repair (TEVAR) with aortic arch vessel bypasses are successfully adopted. This paper reports a successful hybrid management of aortic arch pseudoaneurysm in a 66 year old female patient known to be hypertensive, diabetic,smoker dyslipidemic on dialysis and  who underwent one year previously a surgical ascending aortic repair. Aortic arch vessel bypasses -necessary in this case – were facilitated by the presence of an aberrant right subclavian artery known as Arteria Lusoria- This variant, a rare embryologic anomaly of the aortic arch vessels, described by Hunauld in 1735, was used as an inflow artery to the right common carotid allowing the surgeons to avoid a left to right common carotid artery bypass known to be associated with many complications. Although the hybrid management seems a feasible and safe option especially in high risk patients not eligible for open surgical repair, furher clinical studies and development of new devices dedicated to treat ascending aortic diseases are fundamental to improve outcomes.},
 year = {2018}
}

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TY  - JOUR
T1  - Arteria Lusoria Facilitates Hybrid Management of Aortic Arch Pseudoaneurysm
AU  - Simon Bejjani
AU  - Nadine Kawkabani
AU  - Rula Darwish
AU  - Omar Boustros
AU  - Moussa Abi Ghanem
AU  - Bassam Abu Khalil
Y1  - 2018/09/01
PY  - 2018
N1  - https://doi.org/10.11648/j.ijcts.20180403.12
DO  - 10.11648/j.ijcts.20180403.12
T2  - International Journal of Cardiovascular and Thoracic Surgery
JF  - International Journal of Cardiovascular and Thoracic Surgery
JO  - International Journal of Cardiovascular and Thoracic Surgery
SP  - 26
EP  - 29
PB  - Science Publishing Group
SN  - 2575-4882
UR  - https://doi.org/10.11648/j.ijcts.20180403.12
AB  - Classic open ascending aortic replacement is an effective treatment for Stanford type A aortic dissection However it is associated with a mortality ranging between 15 to 60%. This incidence is even higher in recurrent cases. In these patients, hybrid procedures which combine thoracic endovascular aortic repair (TEVAR) with aortic arch vessel bypasses are successfully adopted. This paper reports a successful hybrid management of aortic arch pseudoaneurysm in a 66 year old female patient known to be hypertensive, diabetic,smoker dyslipidemic on dialysis and  who underwent one year previously a surgical ascending aortic repair. Aortic arch vessel bypasses -necessary in this case – were facilitated by the presence of an aberrant right subclavian artery known as Arteria Lusoria- This variant, a rare embryologic anomaly of the aortic arch vessels, described by Hunauld in 1735, was used as an inflow artery to the right common carotid allowing the surgeons to avoid a left to right common carotid artery bypass known to be associated with many complications. Although the hybrid management seems a feasible and safe option especially in high risk patients not eligible for open surgical repair, furher clinical studies and development of new devices dedicated to treat ascending aortic diseases are fundamental to improve outcomes.
VL  - 4
IS  - 3
ER  -

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Author Information

Simon Bejjani

Department of Cardiothoracic Surgery, St Georges Hospital-University Medical Center, University of Balamand, Beirut, Lebanon
Nadine Kawkabani

Department of Cardiac Surgery Anesthesia, St Georges Hospital-University, Medical Center, Beirut, Lebanon
Rula Darwish

Department of Cardiac Surgery Anesthesia, St Georges Hospital-University, Medical Center, Beirut, Lebanon
Omar Boustros

Department of Cardiothoracic Surgery, St Georges Hospital-University Medical Center, University of Balamand, Beirut, Lebanon
Moussa Abi Ghanem

Department of Cardiothoracic Surgery, St Georges Hospital-University Medical Center, Beirut, Lebanon
Bassam Abu Khalil

Department of Cardiothoracic Surgery, St Georges Hospital-University Medical Center, Beirut, Lebanon

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APA Style

Simon Bejjani, Nadine Kawkabani, Rula Darwish, Omar Boustros, Moussa Abi Ghanem, et al. (2018). Arteria Lusoria Facilitates Hybrid Management of Aortic Arch Pseudoaneurysm. International Journal of Cardiovascular and Thoracic Surgery, 4(3), 26-29. https://doi.org/10.11648/j.ijcts.20180403.12

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ACS Style

Simon Bejjani; Nadine Kawkabani; Rula Darwish; Omar Boustros; Moussa Abi Ghanem, et al. Arteria Lusoria Facilitates Hybrid Management of Aortic Arch Pseudoaneurysm. Int. J. Cardiovasc. Thorac. Surg. 2018, 4(3), 26-29. doi: 10.11648/j.ijcts.20180403.12

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AMA Style

Simon Bejjani, Nadine Kawkabani, Rula Darwish, Omar Boustros, Moussa Abi Ghanem, et al. Arteria Lusoria Facilitates Hybrid Management of Aortic Arch Pseudoaneurysm. Int J Cardiovasc Thorac Surg. 2018;4(3):26-29. doi: 10.11648/j.ijcts.20180403.12

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@article{10.11648/j.ijcts.20180403.12,
  author = {Simon Bejjani and Nadine Kawkabani and Rula Darwish and Omar Boustros and Moussa Abi Ghanem and Bassam Abu Khalil},
  title = {Arteria Lusoria Facilitates Hybrid Management of Aortic Arch Pseudoaneurysm},
  journal = {International Journal of Cardiovascular and Thoracic Surgery},
  volume = {4},
  number = {3},
  pages = {26-29},
  doi = {10.11648/j.ijcts.20180403.12},
  url = {https://doi.org/10.11648/j.ijcts.20180403.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20180403.12},
  abstract = {Classic open ascending aortic replacement is an effective treatment for Stanford type A aortic dissection However it is associated with a mortality ranging between 15 to 60%. This incidence is even higher in recurrent cases. In these patients, hybrid procedures which combine thoracic endovascular aortic repair (TEVAR) with aortic arch vessel bypasses are successfully adopted. This paper reports a successful hybrid management of aortic arch pseudoaneurysm in a 66 year old female patient known to be hypertensive, diabetic,smoker dyslipidemic on dialysis and  who underwent one year previously a surgical ascending aortic repair. Aortic arch vessel bypasses -necessary in this case – were facilitated by the presence of an aberrant right subclavian artery known as Arteria Lusoria- This variant, a rare embryologic anomaly of the aortic arch vessels, described by Hunauld in 1735, was used as an inflow artery to the right common carotid allowing the surgeons to avoid a left to right common carotid artery bypass known to be associated with many complications. Although the hybrid management seems a feasible and safe option especially in high risk patients not eligible for open surgical repair, furher clinical studies and development of new devices dedicated to treat ascending aortic diseases are fundamental to improve outcomes.},
 year = {2018}
}

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TY  - JOUR
T1  - Arteria Lusoria Facilitates Hybrid Management of Aortic Arch Pseudoaneurysm
AU  - Simon Bejjani
AU  - Nadine Kawkabani
AU  - Rula Darwish
AU  - Omar Boustros
AU  - Moussa Abi Ghanem
AU  - Bassam Abu Khalil
Y1  - 2018/09/01
PY  - 2018
N1  - https://doi.org/10.11648/j.ijcts.20180403.12
DO  - 10.11648/j.ijcts.20180403.12
T2  - International Journal of Cardiovascular and Thoracic Surgery
JF  - International Journal of Cardiovascular and Thoracic Surgery
JO  - International Journal of Cardiovascular and Thoracic Surgery
SP  - 26
EP  - 29
PB  - Science Publishing Group
SN  - 2575-4882
UR  - https://doi.org/10.11648/j.ijcts.20180403.12
AB  - Classic open ascending aortic replacement is an effective treatment for Stanford type A aortic dissection However it is associated with a mortality ranging between 15 to 60%. This incidence is even higher in recurrent cases. In these patients, hybrid procedures which combine thoracic endovascular aortic repair (TEVAR) with aortic arch vessel bypasses are successfully adopted. This paper reports a successful hybrid management of aortic arch pseudoaneurysm in a 66 year old female patient known to be hypertensive, diabetic,smoker dyslipidemic on dialysis and  who underwent one year previously a surgical ascending aortic repair. Aortic arch vessel bypasses -necessary in this case – were facilitated by the presence of an aberrant right subclavian artery known as Arteria Lusoria- This variant, a rare embryologic anomaly of the aortic arch vessels, described by Hunauld in 1735, was used as an inflow artery to the right common carotid allowing the surgeons to avoid a left to right common carotid artery bypass known to be associated with many complications. Although the hybrid management seems a feasible and safe option especially in high risk patients not eligible for open surgical repair, furher clinical studies and development of new devices dedicated to treat ascending aortic diseases are fundamental to improve outcomes.
VL  - 4
IS  - 3
ER  -

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