title: Repair of complicated type B dissection with an isolated left vertebral artery using the stented elephant trunk technique.
abstract: OBJECTIVE
  The presence of an isolated left vertebral artery (ILVA) remains a challenging issue for thoracic endovascular aortic repair (TEVAR) of type B dissection if the proximal landing zones are inadequate. We retrospectively reviewed our experience of the surgical management of complicated type B dissection with an ILVA using the stented elephant trunk technique.
  
  
  METHODS
  Between February 2009 and May 2013, 7 patients with complicated type B dissection (acute = 2 and chronic = 5) underwent the stented elephant trunk procedure under hypothermic cardiopulmonary bypass with selective antegrade cerebral perfusion. All the patients were males with a median age of 53 ± 6 (range 42-59) years. Preoperative lower limb ischaemia was observed in 1 patient, renal dysfunction in 1 patient and visceral ischaemia in 1 patient.
  
  
  RESULTS
  There were no in-hospital deaths. The median ventilator support time was 16 ± 3 (range 11-20) h. Ischaemia of the lower limb and viscera was ameliorated after surgical stent-graft implantation. Continuous renal replacement therapy was not required in patients with preoperative renal dysfunction after surgery. No neurological deficits were observed in any patients prior to hospital discharge. One patient underwent TEVAR due to distal aortic dilatation within the mean follow-up period, which was 44 ± 19 months.
  
  
  CONCLUSIONS
  Repair of complicated type B dissection with an ILVA using the stented elephant trunk technique was associated with satisfactory surgical results in patients with inadequate proximal fixation zones. This technique is an alternative to TEVAR for complicated type B dissection with inadequate proximal landing zones.
authors.affiliation: Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Jun-Ming
authors.initials: JM
authors.lastname: Zhu
authors.affiliation: Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Rui-Dong
authors.initials: RD
authors.lastname: Qi
authors.affiliation: Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Yong-Min
authors.initials: YM
authors.lastname: Liu
authors.affiliation: Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Zheng
authors.affiliation: Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Xiao-Yan
authors.initials: XY
authors.lastname: Xing
authors.affiliation: Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China lizhongsun@outlook.com.
authors.forename: Li-Zhong
authors.initials: LZ
authors.lastname: Sun
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Isolated left vertebral artery; Stented elephant trunk technique; Type B dissection