Carotid-Carotid Transposition for Zone 1 Thoracic Endovascular Aortic Repair

Roberto G. Aru, Sam C. Tyagi, David J. Minion, Nathan T. Orr, Michael C. Bounds

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: Carotid-carotid bypass is the standard technique for cervical aortic arch debranching to maintain left common carotid artery perfusion with zone I thoracic endovascular aortic repair (TEVAR), while left-to-right carotid-carotid transposition (CCT) has been described as an autologous alternative. We report on our center's experience with CCT in the setting of zone I TEVAR. This is the only published series of this technique. Methods: All patients who underwent CCT, defined by CPT code 35509, between 2017 and 2020 were identified at our tertiary care center. Patient demographics, indications for CCT, complications specific to CCT, operative details, post-operative course, and outcomes were retrospectively reviewed. Results: A total of 13 patients underwent CCT prior to zone 1 TEVAR. The indications for intervention were thoracic or thoracoabdominal aortic aneurysms and dissections secondary to hypertension (n = 10), Marfan syndrome (n = 2), and Turner syndrome with aneurysmal degeneration of previous coarctation repair (n = 1). There was a high incidence of preexisting hypertension (92%), malnutrition (69%), and smoking (61%) in this cohort. Operative intervention was performed on both an elective (n = 7, 54%) and an urgent (n = 6, 46%) basis. Complications directly related to CCT included transient unilateral recurrent laryngeal nerve deficit (n = 1, 7.7%). There were no cerebrovascular events, surgical site infections, or procedure-related mortalities. All transpositions with follow-up imaging were patent without stenosis or thrombosis (average 7.2 months, n = 10). There were no late complications related to CCT. Conclusions: CCT is a safe and autologous alternative to carotid-carotid bypass for left common carotid artery revascularization with zone I TEVAR.

Original languageEnglish
Pages (from-to)325-329
Number of pages5
JournalAnnals of Vascular Surgery
Volume76
DOIs
StatePublished - Oct 2021

Bibliographical note

Publisher Copyright:
© 2021

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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