At follow up after two weeks his echo showed well placed coarctation stent (as shown in fig-3) with residual PG of 15 mmHg and pulsatile flow abdominal aorta and preserve flow in left Subclavian artery
a) Ascending aorta (black arrow), descending aorta (open arrow), (b) aortic arch (star) and aberrant origin of left subclavian artery
with diverticulum of Kommerell (black arrow).
Left subclavian artery
was divided distal to the left vertebral artery and distal aortic arch was repaired with the subsequent subclavian flap.
We are of the view that the accurate prospective radiological reporting of this anomaly is important, especially in the context of endovascular stent procedures of aortic arch lesions, as the left subclavian artery
perfusion would in such cases depend on the subclavian steal phenomenon from a normal left vertebral artery.
The two most common aortic arch anomalies that cause airway compression are (1) a double aortic arch and (2) a right aortic arch with an aberrant left subclavian artery
and left ligamentum arteriosum.
Because the longest distance between the orifices of the innominate artery and left subclavian artery
The aortic aneurysm was repaired using three endovascular stent grafts (42 mm x 216 mm, 42 mm x 135 mm, and 42 mm x 162 mm, Zenith TX2, Cook Medical, Bloomington, IN, USA), and one distal bare-metal stent graft (30 mm x 147 mm, Zenith TX2, Cook Medical, Bloomington, IN, USA) that extended from the aortic arch to the beginning of the abdominal aorta [Figure 2]a and b, followed by ligation of the proximal left carotid artery and coil embolization of the left subclavian artery
Aortic aneurysm opened, multiple large clots removed, diaphragm transected and PTFE 20 mm x 30 cm graft anastomosed to descending aorta just beyond the origin of left subclavian artery
In 2014, Gore initiated a clinical study evaluating the use of the same device for the treatment of thoracic aortic aneurysms that require coverage of the left subclavian artery
Objective: To study the vertebral levels of formation and termination of superior vena cava (SVC) and the vertebral level of origin of brachiocephalic trunk, left common carotid artery, and left subclavian artery
in Indian subjects, and to describe their role in vascular interventions.
Two of these were ectopic with one arising from the left subclavian artery
[Figure 4a and 4b].
The proximal left subclavian artery
was not accessible for the study.