title: Aberrant left vertebral artery transposition and concomitant carotid-subclavian bypass for treatment of acute intramural hematoma with thoracic endovascular aortic repair.
abstract: Aberrant left vertebral artery (LVA) origin off the aortic arch is an uncommon anatomic variant. Treatment of the thoracic aortic pathology that necessitates its coverage has not been described. We present a patient with an acute intramural hematoma with a dominant LVA originating from the aortic arch. A LVA-to-carotid artery transposition with shunt placement, carotid-to-subclavian bypass, and thoracic endovascular aortic repair were performed. The patient recovered uneventfully, without any evidence of stroke. This case study shows that aberrant left vertebral anatomy presents a unique and interesting challenge and that vertebral shunt techniques during revascularization can be performed without stroke.
authors.affiliation: Division of Vascular and Endovascular Surgery, New York University Langone Medical Center, New York, NY. Electronic address: sheila.blumberg@nyumc.org.
authors.forename: Sheila N
authors.initials: SN
authors.lastname: Blumberg
authors.affiliation: Division of Vascular and Endovascular Surgery, New York University Langone Medical Center, New York, NY.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Adelman
authors.affiliation: Division of Vascular and Endovascular Surgery, New York University Langone Medical Center, New York, NY.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Maldonado
mesh_terms: D001013:Aorta, Thoracic / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures; D006406:Hematoma / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D014711:Vertebral Artery / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*