Contemporary Imaging Findings in Aortic Arch Surgery
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Purpose of Review
The purpose of this manuscript is to review the surgical techniques of aortic arch repair, imaging techniques for evaluating the pre- and post-operative aortic arch, and both normal and abnormal post-operative imaging appearances.
Aortic arch repair is a technically challenging and rapidly evolving procedure, utilizing a variety of surgical methods that result in variable imaging appearances. Imaging plays an important role in the diagnosis of aortic arch abnormalities, as well as diagnosis of abnormalities in the adjacent ascending and descending aorta. Imaging also plays a key role in post-operative evaluation and surveillance.
Familiarity with aortic arch surgical procedures and their expected post-operative imaging appearances is crucial for the radiologist to identify the surgery performed, recognize surgical complications, and avoid imaging pitfalls that may be mistaken for complications.
KeywordsAortic arch repair Hybrid aortic repair Elephant trunk Frozen elephant trunk
Compliance with Ethical Guidelines
Conflict of interest
Bang, Green, Reece, DaBreo, and Vargas declare no conflicts of interest.
Papers of particular interest, published recently, have been highlighted as: • Important •• Very important
- 1.••Zanotti G, Reece TB, Aftab M. Aortic arch pathology: Surgical options for the aortic arch replacement. Cardiol Clin. 2017;35(3):367–85. https://doi.org/10.1016/j.ccl.2017.03.006. This paper provides a comprehensive review of surgical techniques for surgical and hybrid techniques in aortic arch repair. CrossRefGoogle Scholar
- 2.••Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE Jr, et al. ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons,and Society for Vascular Medicine. J Am Coll Cardiol. 2010;55(14):e27–129. https://doi.org/10.1016/j.jacc.2010.02.015. This paper describes the American College of Cardiology Foundation/American Heart Association Task Force practice guidelines for thoracic aortic disease. CrossRefGoogle Scholar
- 12.Kazui T, Washiyama N, Muhammad BA, Terada H, Yamashita K, Takinami M, et al. Total arch replacement using aortic arch branched grafts with the aid of antegrade selective cerebral perfusion. Ann Thorac Surg. 2000;70(1):3–8. https://doi.org/10.1016/s0003-4975(00)01535-6 (Discussion 9).CrossRefPubMedGoogle Scholar
- 14.LeMaire SA, Weldon SA, Coselli JS. Total aortic arch replacement: current approach using the trifurcated graft technique. Ann Cardiothorac Surg. 2013;2(3):347–52. https://doi.org/10.3978/j.issn.2225-319X.2013.05.02.CrossRefPubMedPubMedCentralGoogle Scholar
- 16.••Latson LA Jr, DeAnda A Jr, Ko JP. Imaging of the postsurgical thoracic aorta: a state-of-the-art review. J Thorac Imaging. 2017;32(1):1–25. https://doi.org/10.1097/RTI.0000000000000246. Comprehensive review of imaging techniques for pre- and post-operative imaging of the aorta, as well as normal and abnormal post-operative imaging appearances. CrossRefGoogle Scholar
- 17.Suto Y, Yasuda K, Shiiya N, Murashita T, Kawasaki M, Imamura M, et al. Stented elephant trunk procedure for an extensive aneurysm involving distal aortic arch and descending aorta. J Thorac Cardiovasc Surg. 1996;112(5):1389–90. https://doi.org/10.1016/S0022-5223(96)70157-5.CrossRefPubMedGoogle Scholar
- 20.Mita T, Arita T, Matsunaga N, Furukawa M, Zempo N, Esato K, et al. Complications of endovascular repair for thoracic and abdominal aortic aneurysm: an imaging spectrum. Radiographics. 2000;20(5):1263–78. https://doi.org/10.1148/radiographics.20.5.g00se161263.CrossRefPubMedGoogle Scholar
- 23.Sakata M, Takehara Y, Katahashi K, Sano M, Inuzuka K, Yamamoto N, et al. Hemodynamic analysis of endoleaks after endovascular abdominal aortic aneurysm repair by using 4-dimensional flow-sensitive magnetic resonance imaging. Circ J. 2016;80(8):1715–25. https://doi.org/10.1253/circj.CJ-16-0297.CrossRefPubMedGoogle Scholar
- 24.Katahashi K, Sano M, Takehara Y, Inuzuka K, Sugiyama M, Alley MT, et al. Flow dynamics of type II endoleaks can determine sac expansion after endovascular aneurysm repair using four-dimensional flow-sensitive magnetic resonance imaging analysis. J Vasc Surg. 2019;70(1):107–16. https://doi.org/10.1016/j.jvs.2018.09.048 (e1).CrossRefPubMedGoogle Scholar
- 25.Kpodonu J, Preventza O, Ramaiah VG, Shennib H, Wheatley GH 3rd, Rodriquez-Lopez J, et al. Retrograde type A dissection after endovascular stenting of the descending thoracic aorta. Is the risk real? Eur J Cardiothorac Surg. 2008;33(6):1014–8. https://doi.org/10.1016/j.ejcts.2008.03.024.CrossRefPubMedGoogle Scholar