Coverage of the left subclavian artery without revascularization during thoracic endovascular repair is feasible: a prospective study

Ann Vasc Surg. 2014 May;28(4):850-9. doi: 10.1016/j.avsg.2013.10.001. Epub 2013 Oct 27.

Abstract

Background: To effectively isolate thoracic aortic lesions in thoracic endovascular aortic repair (TEVAR), an adequate proximal landing zone length is required. The left subclavian artery (LSCA) and other branches of the aortic arch commonly impose limitations on proximal landing zone length, restricting the use of TEVAR. In this study, we investigated the outcomes of LSCA coverage during TEVAR.

Methods: Between March 2009 and February 2010, we recruited patients with thoracic dissection, aneurysm or trauma from a single center for TEVAR. We categorized patients into 3 groups: full coverage, partial coverage, or noncoverage of the LSCA. We measured pre- and postoperative blood pressures and evaluated complications during follow-up.

Results: We recruited 111 patients for our study: 55 (50%) and 25 (23%) patients had full and partial LSCA coverage, respectively. The upper left arm blood pressures before and after the operations were significantly different between the full-coverage group and the other groups (P < 0.0001). Follow-up occurred between 6 and 20 months, and the mean follow-up time was 10.4 months. Thirteen patients (24%) in the full-coverage group and 2 patients (8%) in the partial-coverage group suffered from simple vertebrobasilar ischemia (VBI). Eleven of the patients with VBI (20%) in the full-coverage group and 2 (8%) patients with VBI in the partial-coverage group had left subclavian steal syndrome at follow-up. No paraplegia or stroke was observed.

Conclusions: Intentional coverage of the LSCA to obtain an adequate proximal landing zone for TEVAR can be a treatment option for thoracic aortic lesions, although some patients experienced mil complications.

MeSH terms

  • Adult
  • Aged
  • Aorta, Thoracic / injuries
  • Aorta, Thoracic / physiopathology
  • Aorta, Thoracic / surgery*
  • Aortic Aneurysm, Thoracic / diagnosis
  • Aortic Aneurysm, Thoracic / mortality
  • Aortic Aneurysm, Thoracic / physiopathology
  • Aortic Aneurysm, Thoracic / surgery*
  • Aortic Dissection / diagnosis
  • Aortic Dissection / mortality
  • Aortic Dissection / physiopathology
  • Aortic Dissection / surgery*
  • Blood Vessel Prosthesis
  • Blood Vessel Prosthesis Implantation / adverse effects
  • Blood Vessel Prosthesis Implantation / instrumentation
  • Blood Vessel Prosthesis Implantation / methods*
  • Blood Vessel Prosthesis Implantation / mortality
  • China
  • Endovascular Procedures / adverse effects
  • Endovascular Procedures / instrumentation
  • Endovascular Procedures / methods*
  • Endovascular Procedures / mortality
  • Feasibility Studies
  • Female
  • Hemodynamics
  • Hospital Mortality
  • Humans
  • Linear Models
  • Male
  • Middle Aged
  • Prospective Studies
  • Prosthesis Design
  • Risk Factors
  • Subclavian Artery / surgery*
  • Subclavian Steal Syndrome / etiology
  • Subclavian Steal Syndrome / physiopathology
  • Time Factors
  • Treatment Outcome
  • Vascular System Injuries / diagnosis
  • Vascular System Injuries / mortality
  • Vascular System Injuries / physiopathology
  • Vascular System Injuries / surgery*
  • Vertebrobasilar Insufficiency / etiology
  • Vertebrobasilar Insufficiency / physiopathology