Total Arch Replacement with Associated Anomaly of the Left Vertebral Artery

Satoshi Yamashiro, MD, Yukio Kuniyoshi, MD, Katsuya Arakaki, MD, Hitoshi Inafuku, MD, Yuji Morishima, MD, and Yuya Kise, MD

We describe total arch replacement after ascending aortic replacement for acute type II dissecting aneurysm with associated anomaly of the left vertebral artery. A female patient was recommended at 10 years of age after the initial operation because of an enlargement of the distal ascending aorta. Magnetic resonance angiography revealed an isolated left vertebral artery that arises distal to the left subclavian artery. Total arch replacement was proceeding using selective cerebral perfusion. The isolated artery was reconstructed with a saphenous vein graft interposed between the native left vertebral artery and the side of the graft branch anastomosed to the left subclavian artery. The patient recovered uneventfully after extensive surgical replacement of the thoracic aorta and remains asymptomatic at 1 year after the procedure. To prevent possible neurological complications, we find it critical to assess vascularization in this region prior to conducting surgical procedure. Careful examination and correct identification of the vessels are essential to avoid major complications. (Ann Thorac Cardiovasc Surg 2010; 16: 216-219)

Key words: total arch replacement, left vertebral artery, anomaly

Thoracic and Cardiovascular Surgery, Department of Bioregulatory Medicine, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan

Received February 10, 2009; accepted for publication April 6, 2009
Address reprint requests to Satoshi Yamashiro, MD, PhD: Thoracic and Cardiovascular Surgery Division, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903–0215, Japan.