{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T11:06:13Z","timestamp":1785150373422,"version":"3.55.0"},"reference-count":26,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T00:00:00Z","timestamp":1761523200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: The aim of this study was to assess the current management strategies of Isolated Left Vertebral Artery (ILVA) arising directly from the aortic arch during total endovascular or hybrid repair of aortic arch pathologies and their safety and efficacy. Methods: A systematic literature review was undertaken to assess the current management strategies for ILVA during total endovascular or hybrid repair of aortic arch pathologies on three databases (PubMed, SCOPUS and Web of Science) from inception to February 2025, according to PICO and PRISMA guidelines (PROSPERO CRD42024562104). The safety (overall and aortic-related mortality; neurological complications) and efficacy (revascularization patency, endoleak and reintervention rate) of both approaches were investigated. Results: Out of 224 articles found, seven retrospective cohort studies (178 patients) were included. Overall, 149 patients (74.2% male, mean age 63 years) underwent ILVA revascularization. Two studies reported open ILVA revascularization through transposition; three studies reported endovascular revascularization strategies, and one study reported both open and endovascular techniques. The overall mortality rate was 1.3% at 30 days and 5.4% at a mean follow-up of 46 months (range 6\u2013120) with a reported rate of aortic mortality of 0.7%. In the transposition group (55 patients), the rate of minor neurological complications was 16.6%, and the rate of major neurological complications was 7.3%; loss of patency rate was 16.3% and reintervention rate was 11.7%. Endovascularly treated patients (94 patients) experienced a rate of minor neurological complications of 2.1% and major neurological complications of 1%; the loss of patency rate was 2.1%, and the reintervention rate was 3.1%. Conclusions: Both surgical and endovascular techniques for ILVA revascularization seem to assure an acceptable rate of mortality and neurological complications during treatment of arch pathologies. However, currently available data are poor, non-standardized and based on single-center experiences. Therefore, until more robust data are available to indicate the superiority of one approach over another, the management strategies for aberrant ILVA should be individualized based on the anatomic characteristics and the center experience. Our findings underscore the need for prospective studies with standardized protocols.<\/jats:p>","DOI":"10.3390\/jcm14217626","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T09:16:24Z","timestamp":1761729384000},"page":"7626","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A Systematic Review of the Literature on the Current Revascularization Strategies for Aberrant Left Vertebral Artery During Total Endovascular and Hybrid Treatment of Aortic Arch Disease"],"prefix":"10.3390","volume":"14","author":[{"given":"Marta","family":"Minucci","sequence":"first","affiliation":[{"name":"Unit of Vascular Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Unit of Vascular Surgery, Department of Cardiovascular Sciences, Universit\u00e0 Cattolica del Sacro Cuore, 20123 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2422-5517","authenticated-orcid":false,"given":"Ottavia","family":"Borghese","sequence":"additional","affiliation":[{"name":"Unit of Vascular Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Unit of Vascular Surgery, Department of Cardiovascular Sciences, Universit\u00e0 Cattolica del Sacro Cuore, 20123 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Luparelli","sequence":"additional","affiliation":[{"name":"Unit of Vascular Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Unit of Vascular Surgery, Department of Cardiovascular Sciences, Universit\u00e0 Cattolica del Sacro Cuore, 20123 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5804-2284","authenticated-orcid":false,"given":"Domenico","family":"Pascucci","sequence":"additional","affiliation":[{"name":"Health Management, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Department of Life Science and Public Health, Universit\u00e0 Cattolica del Sacro Cuore, 20123 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Rascio","sequence":"additional","affiliation":[{"name":"Unit of Vascular Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Unit of Vascular Surgery, Department of Cardiovascular Sciences, Universit\u00e0 Cattolica del Sacro Cuore, 20123 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Tinelli","sequence":"additional","affiliation":[{"name":"Unit of Vascular Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Unit of Vascular Surgery, Department of Cardiovascular Sciences, Universit\u00e0 Cattolica del Sacro Cuore, 20123 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso","family":"Donati","sequence":"additional","affiliation":[{"name":"Unit of Vascular Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Unit of Vascular Surgery, Department of Cardiovascular Sciences, Universit\u00e0 Cattolica del Sacro Cuore, 20123 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7304-7553","authenticated-orcid":false,"given":"Yamume","family":"Tshomba","sequence":"additional","affiliation":[{"name":"Unit of Vascular Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Unit of Vascular Surgery, Department of Cardiovascular Sciences, Universit\u00e0 Cattolica del Sacro Cuore, 20123 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1016\/j.clinimag.2013.07.008","article-title":"Frequency and imaging findings of variations in human aortic arch anatomy based on multidetector computed tomography data","volume":"37","author":"Celikyay","year":"2013","journal-title":"Clin. Imaging"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1016\/j.jvs.2017.06.097","article-title":"A systematic review and meta-analysis of variations in branching patterns of the adult aortic arch","volume":"68","author":"Popieluszko","year":"2018","journal-title":"J. Vasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1586","DOI":"10.1016\/j.jtcvs.2015.02.019","article-title":"Atypical aortic arch branching variants: A novel marker for thoracic aortic disease","volume":"149","author":"Dumfarth","year":"2015","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1007\/s00276-018-1987-3","article-title":"A systematic classification of the vertebral artery variable origin: Clinical and surgical implications","volume":"40","author":"Lazaridis","year":"2018","journal-title":"Surg. Radiol. Anat."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1093\/ejcts\/ezt609","article-title":"Vertebral artery variations in thoracic aortic patients","volume":"46","author":"Ohkura","year":"2014","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Shi, R., and Wooster, M. (2024). Hybrid and Endovascular Management of Aortic Arch Pathology. J. Clin. Med., 13.","DOI":"10.3390\/jcm13206248"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.jvs.2007.10.032","article-title":"International controlled clinical trial of thoracic endovascular aneurysm repair with the Zenith TX2 endovascular graft: 1-year results","volume":"47","author":"Matsumura","year":"2008","journal-title":"J. Vasc. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Yang, G., Chen, H., Sun, G., Lou, W., Chen, X., and Zhang, L. (2021). Transposition of Isolated Left Vertebral Artery in Hybrid Thoracic Endovascular Aortic Repair. Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.783656"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.ejvs.2022.11.007","article-title":"Management of an Isolated Left Vertebral Artery on the Arch During Zone 2 Landing Thoracic Endovascular Aortic Repair: A Multicentre Retrospective Study","volume":"65","author":"Zhang","year":"2023","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Luo, Z.R., Li, S.L., Chen, L.W., and Huang, R.D. (2024). Utilizing physician modified fenestration on the castor branched stent technique for reconstruction of an isolated left vertebral artery on the aortic arch. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-54781-8"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"467","DOI":"10.7326\/M18-0850","article-title":"PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation","volume":"169","author":"Tricco","year":"2018","journal-title":"Ann. Intern Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"S4","DOI":"10.1016\/j.jvs.2020.06.011","article-title":"Reporting standards for endovascular aortic repair of aneurysms involving the renal-mesenteric arteries","volume":"73","author":"Oderich","year":"2021","journal-title":"J. Vasc. Surg."},{"key":"ref_14","unstructured":"Wells, G., Shea, B., O\u2019 Connell, D., Peterson, J., Welch, V., Losos, M., and Tugwell, P. (2014). The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomized Studies in Meta-Analyses, Ottawa Hospital Research Institute."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2189","DOI":"10.1016\/j.jtcvs.2019.06.011","article-title":"Transposition of the left vertebral artery during endovascular stent-graft repair of the aortic arch","volume":"159","author":"Piffaretti","year":"2020","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1016\/j.jvs.2018.11.052","article-title":"Management of type B aortic dissection with an isolated left vertebral artery","volume":"70","author":"Ding","year":"2019","journal-title":"J. Vasc. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Shen, P., Li, D., Wu, Z., He, Y., Wang, X., Shang, T., Zhu, Q., Tian, L., Li, Z., and Zhang, H. (2023). Physician-modified fenestration or in situ fenestration for preservation of isolated left vertebral artery in thoracic endovascular aortic repair. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1055549"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Wang, Z., Fang, C., Song, H., Wei, D., Meng, X., Bai, X., Liu, C., and Zhao, X. (2023). Endovascular repair of thoracic aortic disease with isolated left vertebral artery and unfavorable proximal landing zone using fenestrated castor stent-graft. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1168180"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1016\/j.jvs.2024.01.018","article-title":"Comparative study of left vertebral artery revascularization in patients with and without aberrant left vertebral anatomy","volume":"79","author":"Shergill","year":"2024","journal-title":"J. Vasc. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1486","DOI":"10.1016\/j.jvs.2022.05.027","article-title":"Transposition of anomalous left vertebral to carotid artery during the management of thoracic aortic dissections and aneurysms","volume":"76","author":"Potter","year":"2022","journal-title":"J. Vasc. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1654","DOI":"10.1177\/15266028231215972","article-title":"Spinal Cord Protection During Thoracic and Thoracoabdominal Endovascular Aortic Repair: 5-Year Results of a Preventive Protocol Including Prophylactic Cerebrospinal Fluid Drainage in High-Risk Patients","volume":"32","author":"Borghese","year":"2023","journal-title":"J. Endovasc. Ther."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1007\/s00270-023-03537-4","article-title":"Comparison of Chimney and Fenestrated Techniques for Supra-Aortic Branch Revascularization During Thoracic Endovascular Aortic Repair: A Systematic Review and Meta-Analysis","volume":"46","author":"Liu","year":"2023","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.ejvs.2011.12.009","article-title":"Analysis of stroke after TEVAR involving the aortic arch","volume":"43","author":"Melissano","year":"2012","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"559","DOI":"10.23736\/S0021-9509.18.10412-5","article-title":"Total endovascular arch repair is the procedure of the future","volume":"59","author":"Spanos","year":"2018","journal-title":"J. Cardiovasc. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.ejvs.2016.06.005","article-title":"Editor\u2019s Choice\u2014Management of Descending Thoracic Aorta Diseases: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)","volume":"53","author":"Riambau","year":"2017","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.ejvs.2022.04.011","article-title":"Editor\u2019s Choice\u2014European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease","volume":"65","author":"Naylor","year":"2023","journal-title":"Eur. J. Vasc. Endovasc. 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