Comparison of Two Different Techniques for Isolated Left Subclavian Artery Revascularization During Thoracic Endovascular Aortic Repair in Zone 2

Abstract

Management of the left subclavian artery (LSA) during thoracic endovascular aortic repair (TEVAR) has generated considerable debate, especially in terms of prevention of stroke and spinal cord ischemia (SCI). 1-8 The most recent guidelines advocated selective LSA revascularization in most thoracic aortic pathologies. 9-11 Although different techniques and approaches are in use, 12-15 there has been no prior study or analysis comparing open LSA revascularization with other options such as chimney grafts (CGs). The aim of this study was to examine the results of TEVAR with isolated LSA revascularization using carotid-subclavian bypass (CSbp) or CGs. Methods Study Design and Study Sample A retrospective multicenter, observational study (ISLA) was conducted to identify all patients with acute or chronic thoracic aortic lesions who underwent TEVAR with isolated LSA revascularization using either CSbp or CGs from 802581J ETXXX10.

Early and Mid-Term Outcomes of Open versus Endovascular Left Subclavian Artery Debranching for Thoracic Aortic Diseases

“… 6) In fact, there are only four studies exclusively comparing carotid–subclavian bypasses or subclavian–carotid transposition to chimney or periscope–sandwich grafts for LSA debranching. 8 , 15 – 17) Table 4 demonstrates their results along with studies that examined either open or parallel graft-based LSA debranching only. 2 , 4 , 6 , 9 , 18) A former study from the reporting institution also described results of periscope–sandwich grafts for LSA debranching, but as only some of the patients were included into the presented cohort, their results were not used for comparison.…”

“…As in our study, statistical differences were neither detected for strokes, mortality, or reintervention rate. 8 , 15 – 17) …”

Alternative Techniques for Treatment of Thoracic Aneurysms without Ideal Anatomy

“…In the meta-analysis published in 2016 [15], which compared retrospective studies, they found a stroke rate of 2.2% to 5.8% for patients with left subclavian artery revascularization and from 7.8% to 9.1% In those who did not revascularize, with respect to spinal cord ischemia, a rate of 2.7% was reported for those patients with revascularization and 4.3% for those patients without revascularization of the left subclavian artery, without statistical significance for these results, but with a trend in favor of revascularization of the left subclavian artery.…”

“…Factors related to stroke and spinal ischemia include the duration of the procedure, the degree of underlying aortic disease, device navigation and release, the number of prostheses used in aortic repair, occlusion below T10, insufficiency renal and female sex [15][16][17][18]. Mortality from revascularization and non-revascularization of the left subclavian artery in hybrid procedures is similar, 3.1% to 4.3% respectively.…”

Reparación endovascular de aorta torácica con técnica de doble chimenea: una alternativa a la cirugía de arco aórtico posterior a la realización de Bentall-Bono en la disección aórtica tipo A

“…Dentro de la literatura, encontramos estudios donde se busca la preservación del flujo en la arteria subclavia 7,8 , e igualmente comparación entre la realización de bypass carótido-subclavio vs. manejo endovascular, sin encontrar diferencias significativas 9 , sin embargo, no hay mucha evidencia en el manejo con chimeneas del resto de los vasos supraaórticos 5,[10][11][12] . En la poca evidencia encontrada se observa que el manejo de zonas de anclaje más proximales se reserva a patología del arco aórtico y aorta ascendente 5,11,13,14 .…”