Effect of Left Subclavian Artery Revascularisation in Thoracic Endovascular Aortic Repair: A Systematic Review and Meta-analysis

Huang, Qun; Chen, Xiao M.; Yang, Han; Qiu, Lin; Qin, Xiao

doi:10.1016/j.ejvs.2018.07.018

Cited by 49 publications

(24 citation statements)

References 29 publications

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“… 22) A meta-analysis of 16 cohort studies with 2591 zone 2 TEVAR patients found that LSA revascularization was associated with a significantly lower perioperative spinal cord ischemia rate and stroke rate, so it is recommended in this review that LSA-covered patients should be considered for revascularization for the duration of TEVAR. 23) However, others reported that LSA revascularization was associated with an increased risk of aortic events or worse clinical outcomes compared with those without revascularization. 24 , 25) Balancing the pros and cons should be considered in individualized decision-making.…”

Section: Discussionmentioning

confidence: 99%

Safety of Left Subclavian Artery Selective Coverage without Revascularization in Thoracic Endovascular Aortic Repair for Type B Aortic Dissections

Sun

Wang

Zhou

et al. 2023

ATCS

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Whether to proceed left subclavian artery (LSA) revascularization in patients with LSA coverage due to insufficient proximal landing zone (PLZ) during thoracic endovascular aortic repair (TEVAR) remains controversial. Methods: A total of 903 patients who received TEVAR were retrospectively analyzed. LSA could be covered if the PLZ was less than 15 mm accompanied with 1) a dominant or balanced right vertebral artery, 2) a complete circle of Willis, and 3) a left vertebral artery with a diameter ≥3 mm and without severe stenosis. Results: LSA selective coverage was necessary for 35.0% (316/903) of the patients to extend the PLZ. Patients presented with weakness, pain, cooling and discoloration of the left upper extremity (LUE), and pulselessness of the left brachial artery were more in the LSA-covered group. The ischemia of LUE occurred more often in patients with LSA covered completely than in those with LSA covered partially. Functional arm status showed no significant difference in the arm, shoulder, and hand questionnaire scores at 12 months postoperative between the LSA-covered group and LSA-uncovered group, or between the LSA-covered completely group and LSA-covered partially group. Conclusion: It was safe to cover the LSA origin without revascularization if the PLZ was less than 15 mm accompanied with careful evaluation (description in method).

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Section: Discussionmentioning

confidence: 99%

Safety of Left Subclavian Artery Selective Coverage without Revascularization in Thoracic Endovascular Aortic Repair for Type B Aortic Dissections

Sun

Wang

Zhou

et al. 2023

ATCS

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“…32 A Cochrane review concluded: “It is not possible to draw conclusions with regard to the optimal management of LSA coverage in TEVAR.” 23 A number of reviews on the need for LSA revascularization yield conflicting information possibly due to the retrospective nature of the studies where an unclear number of patients were revascularized selectively. 23,32-35…”

Section: Discussionmentioning

confidence: 99%

Anatomic Utility of Single Branched Thoracic Endograft During Thoracic Endovascular Aortic Repair

Kumins

Ambani

Bose

et al. 2023

Vasc Endovascular Surg

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Introduction Single branched thoracic endografts (SBTEs) have been designed for pathology requiring zone 2 seal during thoracic endovascular aortic repair (TEVAR). Numerous criteria must be met to allow for their implantation. Our aim was to analyze anatomic suitability for a next generation SBTE. Methods We reviewed 150 TEVAR procedures between 2015 and 2019. Proximal seal was: zone 0 in 21 (16%), zone 1 in 4 (3%), zone 2 in 52 (40%), zone 3 in 45 (35%), and zone 4 or distal in 7 (5%). We analyzed the Zone 2 patient’s angiograms and CT angiograms using centerline software to measure arterial diameters and length in relation to the left common carotid artery (LCCA), left subclavian artery (LSA) and proximal extent of aortic disease to determine if patients met anatomic criteria of a novel SBTE. Results Zone 2 average age was 64.4 ± 16.3 years; 34 patients were male (65%). Indications for repair were aneurysm (N = 9, 17%), acute dissection (N = 14, 27%), chronic dissection with aneurysmal degeneration (N = 7, 13%), intramural hematoma (N = 9, 17%), penetrating aortic ulcer (N = 5, 10%), and blunt traumatic aortic injury (BTAI, N = 8, 15%). LSA revascularization occurred in 27 patients (52%). Overall, 20 (38.5%) of the zone 2 patients met anatomic criteria. Patients with dissection met anatomic criteria less frequently than aneurysm (33% [10 of 30] vs 64% [9 of 14]). Patients treated for BTAI rarely met the anatomic criteria (1 of 8, 13%). The main anatomic constraints were an inadequate distance from the LCCA to the LSA takeoff and from the LCCA to the start of the aortic disease process. Conclusion Less than half of patients who require seal in zone 2 met criteria for this SBTE. Patients with aneurysms met anatomic criteria more often than those with dissection. The device would have little applicability in treating patients with BTAI.

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“…As a result of this and other studies, perioperative strokes of both techniques did not show a significant difference and were comparable to the reported 5.4% pooled stroke rate in a large meta-analysis of LSA revascularization and stroke as the primary outcome ( Table 4 ). 19) …”

Section: Discussionmentioning

confidence: 99%

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

Dueppers

Meuli

Reutersberg

et al. 2022

ATCS

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Purpose: To compare open versus endovascular left subclavian artery debranching for thoracic endovascular aortic repair of thoracic aortic pathologies. Methods: This is a retrospective study of patients receiving left subclavian artery debranching in our institution from October 2009 to January 2020. The primary outcome was freedom from aortic reintervention. Secondary outcomes were type I endoleaks, left subclavian artery (LSA) debranching failure, stroke, technical or clinical success, procedure-related reintervention, as well as 30-day or overall all-cause and aorta-related mortality. Results: Forty-eight patients received parallel graft-based (n = 24, ENDO; median age 75 years [70-80 years]) or open (n = 24, OPEN; median age 71 years [59-75 years]) debranching for type B aortic dissection (n = 25), degenerative aneurysm (n = 12), type IA endoleak (n = 6), suture-associated (n = 3) or ostial LSA aneurysm (n = 1), or penetrating aortic ulcer (n = 1). The median follow-up was 36 months (13-61 months). After 16 months, aortic reintervention-free survival in groups OPEN and ENDO was 91% (95% confidence interval [CI]: 79 to 100%) and 86% (73 to 100%) (p = 0.71), respectively. After 36 months, all-cause survival in groups OPEN and ENDO was 74% (95% CI: 55 to 99%) and 79% (95% CI: 64 to 97%) (p = 0.74), respectively; freedom from aorta-related mortality was 81% (95% CI: 62 to 100%) and 91% (95% CI: 80 to 100%) (p = 0.78), respectively. Group OPEN presented less type I endoleaks (OPEN/ENDO = 3/19, p <0.001) and higher technical (OPEN/ENDO = 81/36%, p = 0.003) and clinical success rates (OPEN/ENDO = 67/36%, p = 0.047). No statistical differences were found for other outcomes. Conclusion: Both strategies achieved comparable reintervention and mortality rates, but open debranching should be preferred due to its higher technical and clinical success and less type I endoleaks.

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Effect of Left Subclavian Artery Revascularisation in Thoracic Endovascular Aortic Repair: A Systematic Review and Meta-analysis

Abstract: The results of this review reveal that LSA revascularisation was associated with significantly lower peri-operative stroke and SCI rates. LSA revascularisation should be recommended for patients with LSA coverage in TEVAR. High quality RCTs are needed to further validate the conclusion.

Cited by 49 publications

References 29 publications

Safety of Left Subclavian Artery Selective Coverage without Revascularization in Thoracic Endovascular Aortic Repair for Type B Aortic Dissections

Safety of Left Subclavian Artery Selective Coverage without Revascularization in Thoracic Endovascular Aortic Repair for Type B Aortic Dissections

Anatomic Utility of Single Branched Thoracic Endograft During Thoracic Endovascular Aortic Repair

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

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