scholarly journals Left Vertebral Artery to Common Carotid Artery Transposition in a Patient With Bilateral Vertebral Insufficiency: 3-Dimensional Operative Video

2020 ◽  
Vol 19 (3) ◽  
pp. E301-E302
Author(s):  
Sirin Gandhi ◽  
Claudio Cavallo ◽  
Justin R Mascitelli ◽  
Michael J Nanaszko ◽  
Xiaochun Zhao ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Common Carotid Artery ◽  
Suture Technique ◽  
Posterior Circulation ◽  
Left Vertebral Artery ◽  
Vertebrobasilar Insufficiency ◽  
Subclavian Steal ◽  
Bypass Patency ◽  
Patient Consent

Abstract Extracranial vertebral artery (VA) atherosclerosis is responsible for 14% to 32% of posterior circulation infarctions.1 In the posterior circulation, narrowing of the VA > 30% is significantly associated with strokes. Subclavian artery (SCA) atherosclerosis can produce subclavian steal. Retrograde VA flow around an occluded SCA decreases blood flow to the posterior circulation and causes vertebrobasilar insufficiency (VBI). Flow augmentation to the posterior circulation can be achieved by VA endarterectomy, arterial stenting, VA-common carotid artery (CCA) transposition, or bypass using an interposition graft.2,3 This video illustrates microsurgical revascularization of the proximal VA with VA-CCA transposition. A 58-yr-old man with a prior stroke and chronic right VA occlusion presented with dysarthria and gait instability. Angiographic evaluation confirmed complete midcervical right VA occlusion and left SCA occlusion proximal to VA origin, with subclavian steal. After obtaining patient consent and a failed attempt at endovascular recanalization of the left SCA, a left VA-CCA end-to-side transposition was performed. Neck dissection exposed the left CCA. The thyrocervical trunk served as a landmark to identify the SCA, which was traced proximally to the VA origin. After proximal occlusion, the VA was transected and “fish-mouthed” for end-to-side anastomosis to CCA. An intraluminal, continuous suture technique was used to sew the back walls of this anastomosis. Postoperative computed tomography angiography confirmed bypass patency. Collateral circulation through the thyrocervical and costocervical trunks likely supplied the left arm, and no cerebral, or limb, ischemic symptoms were noted on follow-up. VA-CCA transposition is an uncommon technique for safe and effective revascularization of symptomatic, medically refractory VBI caused by VA occlusion or, as in this case, SCA occlusion with secondary subclavian steal. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Anatomical Variations in the Branching Pattern of Human Aortic Arch: A Cadaveric Study from Central India

ISRN Anatomy ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Virendra Budhiraja ◽  
Rakhi Rastogi ◽  
Vaishali Jain ◽  
Vishal Bankwar ◽  
Shiv Raghuwanshi
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Aortic Arch ◽  
Subclavian Artery ◽  
Common Carotid Artery ◽  
Left Subclavian Artery ◽  
Left Vertebral Artery ◽  
Common Trunk ◽  
Branching Pattern ◽  
Brachiocephalic Trunk

Variations of the branches of aortic arch are due to alteration in the development of certain branchial arch arteries during embryonic period. Knowledge of these variations is important during aortic instrumentation, thoracic, and neck surgeries. In the present study we observed these variations in fifty-two cadavers from Indian populations. In thirty-three (63.5%) cadavers, the aortic arch showed classical branching pattern which includes brachiocephalic trunk, left common carotid artery, and left subclavian artery. In nineteen (36.5%) cadavers it showed variations in the branching pattern, which include the two branches, namely, left subclavian artery and a common trunk in 19.2% cases, four branches, namely, brachiocephalic trunk, left common carotid artery, left vertebral artery, and left subclavian artery in 15.3% cases, and the three branches, namely, common trunk, left vertebral artery, and left subclavian artery in 1.9% cases.

Prior reconstruction of an isolated left vertebral artery for Stanford type A aortic dissection

2020 ◽  
Author(s):  
Yi Zuo ◽  
Zheng-Chun Zhou ◽  
Jian-Jun Ge
Keyword(s):  
Carotid Artery ◽  
Aortic Dissection ◽  
Vertebral Artery ◽  
Common Carotid Artery ◽  
Type A ◽  
Left Common Carotid Artery ◽  
Total Arch Replacement ◽  
Left Vertebral Artery ◽  
Elephant Trunk ◽  
Type A Aortic Dissection

Abstract Although isolated left vertebral artery is a supra-aortic trunk variant, it is not so rare. It may pose additional difficulties during total arch replacement surgeries. The aim of this study was to present our experience with prior reconstruction of isolated left vertebral artery by isolated left vertebral artery–left common carotid artery during total arch replacement combined with stented elephant trunk implantation.

Subclavian steal syndrome

1979 ◽  
Vol 51 (5) ◽  
pp. 628-640 ◽  
Author(s):  
George L. Bohmfalk ◽  
Jim L. Story ◽  
Willis E. Brown ◽  
Arthur E. Marlin
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Vertebral Artery ◽  
Upper Extremity ◽  
Common Carotid Artery ◽  
Subclavian Steal Syndrome ◽  
Artery Ligation ◽  
Subclavian Steal ◽  
The Brain ◽  
Steal Syndrome

✓ Three patients with central nervous system symptoms due to subclavian steal syndrome were treated with proximal vertebral to common carotid artery transposition. Neurological symptoms were relieved or improved in all three, with no decrease in blood pressure or pulse in the ipsilateral upper extremity. The colorful history of this syndrome is reviewed, and the various surgical approaches to its treatment are discussed. Although the literature suggests that the commonly used carotid to subclavian artery bypass graft and other similar extrathoracic procedures are generally safe and effective for relief of symptoms of the steal, there is also evidence that these bypasses may fail to restore antegrade flow in the vertebral artery, and, in fact, may steal from the carotid artery. Thus, the blood flow provided to the brain by these procedures may be hardly more than that provided by vertebral artery ligation, whereas the principal effect is to restore blood flow into the upper extremity. Vertebral artery ligation alone has been used in 20 patients, with neurological improvement in all cases and production of persistent intermittent brachial claudication in only one. These considerations and our patient experience suggest that a relatively simple operation, proximal vertebral to common carotid artery transposition, which emphasizes restoration of flow to the brain rather than to the upper extremity, may be preferable for most patients with neurological symptoms of subclavian steal syndrome.

scholarly journals A Five-Vessel Aortic Arch with an Anomalous Origin of Both Vertebral Arteries and an Aberrant Right Subclavian Artery

2004 ◽  
Vol 10 (4) ◽  
pp. 309-314 ◽  
Author(s):  
P.A. Brouwer ◽  
M.P.S. Souza ◽  
R. Agid ◽  
K.G. terBrugge
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Aortic Arch ◽  
Subclavian Artery ◽  
Common Carotid Artery ◽  
Anomalous Origin ◽  
Aberrant Right Subclavian Artery ◽  
Left Vertebral Artery ◽  
Transverse Foramen ◽  
The Right

In this case presentation we describe a patient with an anomalous origin of the right vertebral artery arising from the right common carotid artery in combination with an aberrant right subclavian artery and a left vertebral artery originating from the arch between the left common carotid artery and left subclavian artery. Hence there were five vessels originating from the aortic arch. The possible embryological mechanism as well as a postulation on the importance of the level of entrance of the vertebral artery in the cervical transverse foramen is discussed.

scholarly journals Ruptured vertebrobasilar junction aneurysm unmasking subclavian steal syndrome

2020 ◽  
Vol 11 ◽  
pp. 419
Author(s):  
Vivek Murumkar ◽  
Shumyla Jabeen ◽  
Sameer Peer ◽  
Aravinda Hanumanthapura Ramalingaiah ◽  
Jitender Saini
Keyword(s):  
Vertebral Artery ◽  
Subclavian Artery ◽  
Subclavian Steal Syndrome ◽  
Left Vertebral Artery ◽  
Vertebrobasilar Insufficiency ◽  
Subclavian Steal ◽  
Subclavian Artery Occlusion ◽  
Retrograde Filling ◽  
Vertebrobasilar Junction ◽  
Steal Syndrome

Background: Subclavian steal occurs due to stenosis or occlusion of the subclavian artery or innominate artery proximal to the origin of the vertebral artery. Often asymptomatic, the condition may be unmasked due to symptoms of vertebrobasilar insufficiency triggered by strenuous physical exercise involving the affected upper limb. The association of vertebrobasilar junction (VBJ) aneurysms with subclavian steal syndrome has been rarely reported. Hereby, we present a case of VBJ aneurysm associated with subclavian steal treated successfully with endovascular coiling. Case Description: A 65-year-old female presented in the emergency department with acute severe headache and vomiting with no focal neurological deficits. Non-contrast computed tomography of the brain showed modified Fischer Grade 3 subarachnoid hemorrhage. Subsequent digital subtraction angiogram (DSA) showed VBJ aneurysm directed inferiorly with the left subclavian artery occlusion. There was retrograde filling of the left vertebral artery on right vertebral injection, confirming the diagnosis of subclavian steal. Balloon assisted coiling of the VBJ aneurysm was performed while gaining access through the stenotic left vertebral artery ostium which provided a more favorable hemodynamic stability to the coil mass. Conclusion: Subclavian steal exerting undue hemodynamic stress on vertebrobasilar circulation can be an etiological factor for the development of the flow-related aneurysms. Access to the VBJ aneurysms may be feasible through the stenosed vertebral artery if angioplasty is performed before the coiling of the aneurysm.

scholarly journals Rare cause of Bow Hunter’s syndrome due to an aberrant course of a vertebral artery

2019 ◽  
Vol 12 (7) ◽  
pp. e229584
Author(s):  
Kaishin Tanaka ◽  
Brendan Steinfort
Keyword(s):  
Vertebral Artery ◽  
Male Patient ◽  
Cervical Vertebrae ◽  
Distal Portion ◽  
Posterior Circulation ◽  
Left Vertebral Artery ◽  
Vertebrobasilar Insufficiency ◽  
Rare Entity ◽  
Hunter's Syndrome

Bow Hunter’s syndrome (BHS) is a rare cause of vertebrobasilar insufficiency and is reported to most commonly be caused by vertebral artery impingement on cervical vertebrae osteophytes. We report a case in a 56-year-old male patient who on investigation of recurrent posterior circulation ischaemic strokes was found to have BHS. The aetiology of the syndrome in this patient is due to a particularly unusual aberrancy in the path of the atlantoaxial portion of the culprit left vertebral artery. Aberrancy of the distal portion of the vertebral artery is in itself a rare entity, and there are few reports of it in relation to BHS. The patient in this case was successfully treated with endovascular sacrifice of the vertebral artery with no further dynamic occlusive symptoms.

Subclavian steal syndrome

1979 ◽  
Vol 51 (5) ◽  
pp. 641-643 ◽  
Author(s):  
George L. Bohmfalk ◽  
Jim L. Story ◽  
Willis E. Brown ◽  
Arthur E. Marlin
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Common Carotid Artery ◽  
Subclavian Steal Syndrome ◽  
Flow Rates ◽  
Content Type ◽  
Subclavian Steal ◽  
Before And After ◽  
Antegrade Flow ◽  
Steal Syndrome

✓ Intraoperative vertebral artery blood flow was measured in two patients with symptomatic subclavian steal syndrome, before and after proximal end-to-side vertebral to common carotid artery transposition. This confirmed retrograde flow in the vertebral artery before transposition, and antegrade flow after transposition. The measured flow rates were compared to values in other series involving different operative procedures for correction of symptomatic subclavian steal. The greatest mean antegrade flow rates in the vertebral artery were restored by proximal end-to-side vertebral to common carotid artery transposition.

Multimodality Treatment of a Complex Cervicocerebral Arteriovenous Shunt in a Patient With CHARGE Syndrome

Neurosurgery ◽  
2010 ◽  
Vol 67 (1) ◽  
pp. E208-E209 ◽  
Author(s):  
Shervin R. Dashti ◽  
Robert F. Spetzler ◽  
Min S. Park ◽  
Michael F. Stiefel ◽  
Humain Baharvahdat ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Common Carotid Artery ◽  
Heart Defects ◽  
Charge Syndrome ◽  
Left Common Carotid Artery ◽  
Innominate Vein ◽  
Arteriovenous Shunt ◽  
Left Vertebral Artery ◽  
External Carotid

Abstract OBJECTIVE We present our management of a unique case of complex arteriovenous shunt with vascular steal in the left-sided head and neck vessels in a child with CHARGE (Coloboma of the eye, Heart defects, Atresia of the choanae, Retardation of growth and/or development, Genital and/or urinary abnormalities, and Ear abnormalities and deafness) syndrome. CLINICAL PRESENTATION A 10-year-old girl presented with high-output heart failure. Cerebral angiography revealed high-flow abnormal fistulous connections between the left common carotid artery and innominate vein as well as between the vertebral artery and innominate vein. There was significant collateral blood flow to the fistulae from the left external carotid artery and left thyrocervical and costocervical trunks. INTERVENTION The left vertebral artery-to-innominate vein fistula was occluded by endovascular means during temporary balloon occlusion. The left common carotid artery-to-innominate vein fistula was occluded through neck dissection with surgical clipping. CONCLUSION Combined neurosurgical and endovascular techniques were used successfully to manage a complex arteriovenous fistula in a patient with CHARGE syndrome. Challenges in therapeutic decision making are discussed.

scholarly journals Retroesophageal right subclavian artery associated with a bicarotid trunk and an ectopic origin of vertebral arteries

2021 ◽  
Author(s):  
Barbara Buffoli ◽  
Vincenzo Verzeletti ◽  
Lena Hirtler ◽  
Rita Rezzani ◽  
Luigi Fabrizio Rodella
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Aortic Arch ◽  
Subclavian Artery ◽  
Common Carotid Artery ◽  
Distal Part ◽  
Aberrant Right Subclavian Artery ◽  
Left Vertebral Artery ◽  
Vertebral Arteries ◽  
The Right

AbstractA rare branching pattern of the aortic arch in a female cadaver is reported. An aberrant right subclavian artery originated from the distal part of the aortic arch and following a retroesophageal course was recognized. Next to it, from the left to the right, the left subclavian artery and a short bicarotid trunk originating the left and the right common carotid artery were recognized. An unusual origin of the vertebral arteries was also identified. The left vertebral artery originated directly from the aortic arch, whereas the right vertebral artery originated directly from the right common carotid artery. Retroesophageal right subclavian artery associated with a bicarotid trunk and ectopic origin of vertebral arteries represents an exceptional and noteworthy case.

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