title: Total aortic arch replacement in patients with arch vessel anomalies.
abstract: BACKGROUND
  The presence of anomalous arch vessels has considerable impact on aortic arch reconstruction techniques and cerebral protection methods when the separated graft technique is adopted to perform total arch replacement. We analyzed our experience of total arch replacement in patients with arch vessel anomalies.
  
  
  METHODS
  Among the 220 patients undergoing total arch replacement at our institution, 21 patients (9.5%) had various arch vessel anomalies. Common brachiocephalic trunk was found in 8 patients (3.6%); an isolated left vertebral artery in 9 (4.1%); aberrant right subclavian artery in 3 (1.4%); and coexistent common brachiocephalic trunk and isolated left vertebral artery in 1 (0.5%). In 4 of the 9 patients with isolated left vertebral artery, preoperative diagnosis was possible with magnetic resonance angiography or three-dimensional computed tomography. In cases with common brachiocephalic trunk, total arch replacement could be performed with the usual techniques after separating the innominate and left common carotid arteries from each other. The isolated left vertebral artery was anastomosed to the left subclavian artery graft in 7 patients and to the native left subclavian artery in 2. In the aberrant right subclavian artery variety, a distal aortic anastomosis was performed distal to the orifice of this anomalous artery. The aberrant vessel was reconstructed on the right side of the trachea and esophagus.
  
  
  RESULTS
  There was no early or in-hospital mortality. No neurologic complication attributable to the arch vessel anomalies was found.
  
  
  CONCLUSIONS
  A precise preoperative diagnosis is very important for the selection of an appropriate surgical strategy in patients with arch vessel anomalies. Magnetic resonance angiography and three-dimensional computed tomography may be useful diagnostic tools in these patients.
authors.affiliation: First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan. kazuchi@fj9.so-net.ne.jp
authors.forename: Kazuchika
authors.initials: K
authors.lastname: Suzuki
authors.forename: Teruhisa
authors.initials: T
authors.lastname: Kazui
authors.forename: Abul Hasan Muhammad
authors.initials: AH
authors.lastname: Bashar
authors.forename: Katsushi
authors.initials: K
authors.lastname: Yamashita
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Terada
authors.forename: Naoki
authors.initials: N
authors.lastname: Washiyama
authors.forename: Takayasu
authors.initials: T
authors.lastname: Suzuki
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000601:surgery; D001013:Aorta, Thoracic / Q000002:abnormalities* / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods / Q000706:statistics & numerical data; D016122:Brachiocephalic Trunk / Q000002:abnormalities / Q000601:surgery; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000601:surgery; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D013348:Subclavian Artery / Q000002:abnormalities / Q000601:surgery; D014711:Vertebral Artery / Q000002:abnormalities / Q000601:surgery