AUTHOR=Yang Guangmin , Chen Hongwei , Sun Guangxiao , Lou Wensheng , Chen Xin , Zhang Leiyang 

TITLE=Transposition of Isolated Left Vertebral Artery in Hybrid Thoracic Endovascular Aortic Repair

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.783656

DOI=10.3389/fcvm.2021.783656

ISSN=2297-055X

ABSTRACT=ABSTRACT
Objectives: The aim of this study was to present our experience with the management of isolated left vertebral artery during complex thoracic aortic pathology treated with hybrid thoracic endovascular aortic repair. 
Methods: This is a single-center, respective cohort study. Between June 2016 and June 2020, there were 13 patients (12 men; median age 60 years old, range 42-72 years old) who underwent hybrid procedures were identified with isolated left vertebral artery in our center. Demographics, imaging features, operation details and follow-up in these patients were collected and analyzed.  
Results: In this study, all patients received the hybrid procedure, and the primary technical success rate was 100%. There were no in-hospital deaths. Complication occurred in 2 (15.4%) patients. One patient suffered contrast-induced acute kidney injury (CI-AKI) and recovered before discharge. Another patient required reintervention for acute left-lower-limb ischemia, which was successfully treated using Fogarty catheter embolectomy. Immediate vagus/recurrent laryngeal never palsy, lymphocele, and chylothorax were not observed. The median duration of follow up was 22 months (range, 13-29 months). No neurologic deficits, bypass occlusion or ILVA occlusion or stenosis were observed during the follow up. No aortic rupture, cerebrovascular accident, or spinal cord ischemia was observed during the follow-up period.
Conclusions: Our limited experience reveals that hybrid procedure (TEVAR, ILVA transposition, LCCA-LSA bypass) are relatively safe, feasible and durable for the treatment of thoracic aortic pathology with ILVA. However, further technique durability and larger studies with long-term follow-up periods are warranted.