Optimal Management of Isolated Left Vertebral Artery in Total Arch Replacement With Frozen Elephant Trunk for Aortic Dissection.

Background: The presence of an isolated left vertebral artery (ILVA) in patients with aortic dissection is a rare and challenging condition. This study aims to determine the optimal management of ILVA in patients with aortic dissection undergoing total arch replacement with frozen elephant trunk.

Methods: This retrospective study enrolled 94 patients with ILVA and aortic dissection who underwent total arch replacement with frozen elephant trunk. Patients were divided into 3 groups: 18 patients underwent ligation of ILVA, 52 underwent ILVA-left subclavian artery transposition, and 24 underwent ILVA-left common carotid artery transposition.

Results: Vertebral artery dominance was left dominant in 10.6%, symmetric in 33.0%, and right dominant in 56.4% of patients. Notably, patients who underwent ligation of ILVA had either symmetric or right-dominant vertebral arteries, with no left-dominant cases. No strokes were observed. Paraplegia/paraparesis (11.1% versus 11.5% versus 0%, =0.223), mechanical ventilation time (45 [10-61] hour versus 18 [11-38] hour versus 15 [11-51] hour, =0.855), and long-term survival (log-rank =0.419) were comparable among the 3 groups. Follow-up computed tomographic angiography confirmed patency of the left vertebral artery in all patients who underwent ILVA transposition.

Conclusions: Ligation of ILVA, ILVA-left subclavian artery transposition, and ILVA-left common carotid artery transposition are all feasible and safe strategies for managing ILVA in patients with aortic dissection undergoing total arch replacement with frozen elephant trunk.