Brachiocephalic Artery Debranching to Facilitate Thoracic Endografting

  • Timothy M. Sullivan
  • Adnan Rizvi
Chapter

Abstract

Current requirements for thoracic aortic endografting, based on device Instructions for Use (IFU), include a proximal aortic “neck” measuring at least 2 cm in length. Not infrequently, this neck length is not available in patients with more proximal aneurysmal disease of the descending thoracic aorta, necessitating coverage of the brachiocephalic trunks (most commonly the left subclavian artery) or preemptive revascularization (either bypass with proximal ligation or transposition). The current literature suggests that the intentional coverage of the left subclavian artery during placement of a thoracic endograft may increase the risk of arm ischemia, vertebrobasilar ischemia, and possibly spinal cord ischemia and anterior circulation stroke. When feasible, revascularization should be performed to reduce this risk. In addition, challenging anatomy may increase the risk of inadvertent endograft coverage of the brachiocephalic trunks.

Keywords

Ischemia 

References

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Timothy M. Sullivan
    • 1
    • 2
  • Adnan Rizvi
    • 1
  1. 1.Department of Vascular/Endovascular SurgeryMinneapolis Heart Institute at Abbott Northwestern HospitalMinneapolisUSA
  2. 2.Department of SurgeryUniversity of MinnesotaMinneapolisUSA

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