Great Vessel Disease

The great vessels or supra-aortic trunks (SATs) are most often affected by occlusive disease. Aneurysms of the SATs are much rarer compared with other vascular territories and may be associated with aneurysms or dissections of the ascending aorta and arch or aneurysms in other locations. Treatment of SAT aneurysms has evolved from ligation or exclusion to aneurysm resection with autogenous or prosthetic interposition grafts. There is now a growing body of literature describing the use of endovascular techniques to treat occlusive disease or SAT aneurysms. Hybrid techniques, which combine SAT revascularization by direct or cervical routes with aortic stenting, have also grown in popularity. This review covers anatomy, etiology and aortic arch pathology, clinical presentation, diagnosis, indications for treatment, open reconstruction for occlusive lesions, extrathoracic arterial reconstruction, aortic arch repair, endovascular treatment, and prosthetic SAT graft infection or involvement by tumor. Tables outline distribution of atherosclerotic lesions and extended carotid artery aneurysm studies from 2005 to 2012. Figures show a small subclavian artery aneurysm, thromboembolic occlusi