Journal Pre-proof Endovascular Treatment of Blunt Thoracic Aortic Injuries in Right Arch Vessel Anatomy Heepeel Chang, MD, Neal C. Hadro, MD, Marc A. Norris, Marvin E. Morris, MD PII:
To appear in:
The Annals of Thoracic Surgery
Received Date: 15 May 2019 Revised Date:
18 August 2019
Accepted Date: 29 August 2019
Please cite this article as: Chang H, Hadro NC, Norris MA, Morris ME, Endovascular Treatment of Blunt Thoracic Aortic Injuries in Right Arch Vessel Anatomy, The Annals of Thoracic Surgery (2019), doi: https://doi.org/10.1016/j.athoracsur.2019.08.089. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 by The Society of Thoracic Surgeons
Endovascular Treatment of Blunt Thoracic Aortic Injuries in Right Arch Vessel Anatomy Heepeel Chang, MD, Neal C Hadro, MD, Marc A Norris, Marvin E Morris, MD
Department of Vascular Surgery, Baystate Medical Center, University of Massachusetts Medical School, Springfield, MA, USA
Corresponding Author: Heepeel Chang, MD, 759 Chestnut Street, Department of Vascular Surgery, Baystate Medical Center, University of Massachusetts Medical School, Springfield, MA, 01199, USA [email protected]
Right aortic arch (RAA) is a rare congenital anomaly that is divided into three variations according to the branching of the arch vessels. Two main types are commonly seen: mirrorimage branching (Type I, Figure 1A) and aberrant left subclavian artery (LSA) (Type II, Figure 1B). Although extremely rare, there is also a third type, which involves an isolation of the LSA, arising from the left pulmonary artery via ductus arteriosus (Type III, Supplemental Figure 1) . We present a successful treatment of BTAI in type I RAA and discuss potential implication of subclavian coverage. An otherwise healthy 34-year-old male presented to the hospital after he was ejected from a passenger side on a head-on motor vehicle collision. A computed tomography angiography demonstrated type I RAA arch with 2.3x0.9x0.9cm pseudoaneurysm located 2 cm distal to the right subclavian artery (RSA) (Supplemental figure 2, A-C). Under fluoroscopic guidance, a 24mm×110mm Valiant® thoracic endograft (Medtronic Inc.) was successfully deployed just distal to the RSA (Figure 2, A-B). The postoperative course was uneventful. Arm ischemia is rarely the important indication in normal anatomy; rarely, posterior circulation insufficiency often prompts a delayed bypass. That may be different, however, in patients with a right-sided arch. In a predominantly right-handed population, the risk of right arm claudication may end up being the more common indication for subclavian revascularization for this highly selected group.
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