Surgical treatment of Vascular Rings, Aortic Coarctations and Thoracic Aortic Aneurysms in Patients with Aortic Arch Anomalies

Objective:the purpose of this study is to report our experience in surgical treatment of vascular rings (VR), aortic coarctations and thoracic aortic aneurysms in patients with aortic arch anomalies.

Methods:we analyzed 52 patients with aortic arch anomalies. VR were determined in 10 patients (19.2%): 5 with right aortic arch and 5 with double aortic arch. In this group of patients the main symptom was trachea-esophageal compression. Aortic arch anomalies in conjunction with other aortic pathology were determined in 42 patients (80.8%). Patients of this group had following diseases: coarctation, aneurysms, aortic arch hypoplasia, kinking. In this group 24 patients had ARSA; 16 patients - RAA; 2 patients - DAA. In patients with RAA thoracic segment of left subclavian artery was translocated into left common carotid artery and ligamentum arteriosum was divided. VR division in cases of DAA by dissection of the smaller arch was performed. The management of aortic coarctations and aneurysms with end-to-end anastomosis or graft interposition was carried out. In aneurysm associated cases we advocate the use of distal circulatory support. In patients with aortic coarcrtations and aortic aneurysms right thoracotomy was used when right aortic arch was associated with right sided descending thoracic aorta. Subclavian-to-carotid transposition completed in 16 patients.

Results:in patients with VR there was no in-hospital mortality. The outcomes of surgical interventions were excellent and most patients had complete resolution of symptoms over a period of time. In patients with aortic arch aneurysms and coarctations mortality rate was 14.3%. We had hemorrhagic and neurological complications in 7% and 4.8%.

Conclusions:surgical treatment of coarctation syndrome and aneurysms in patients with anomalies of the aortic arch is accompanied by high mortality and complications rates. Careful preoperative imaging and consideration of the individual anatomy in surgical planning are essential to achieve a successful outcome.