Left subclavian artery revascularization in thoracic endovascular aortic repair: single center’s clinical experiences from 171 patients

Abstract

Background Left subclavian artery revascularization (LSA) is frequently performed in the setting of thoracic endovascular repair (TEVAR). The purpose of this study was to compare different techniques for LSA revascularization during TEVAR. Methods We performed a single center’s retrospective cohort study from 2016 to 2019. Patients were categorized by LSA revascularization methods, including direct coverage without revascularization (Unrevascularized), carotid-subclavian bypass (CSB), fenestrated TEVAR (F-TEVAR). Indications, demographics, operation details, and outcomes were analyzed using standard statistical analysis. Results 171 patients underwent TEVAR with LSA coverage, 16.4% (n = 28) were unrevascularized and the remaining patients underwent CSB (n = 100 [58.5%]) or F-TEVAR (n = 43 [25.1%]). Demographics were similar between the unrevascularized and revascularized groups, except for procedure urgent status (p = 0.005). The incidence of postoperative spinal cord ischemia was significantly higher between unrevascularized and revascularized group (10.7% vs. 1.4%; p = 0.032). There was no difference in 30-day and mid-term rates of mortality, stroke, and left upper extremity ischemia. CSB was more likely time-consuming than F-TEVAR [3.25 (2.83–4) vs. 2 (1.67–2.67) hours, p = 0], but there were no statistically significant differences in 30-day or midterm outcomes for CSB versus F-TEVAR. During a mean follow-up time of 24.8 months, estimates survival rates had no difference. Conclusions LSA revascularization in zone 2 TEVAR is necessary which is associated with a low 30-day rate of spinal cord ischemia. When LSA revascularization is required during TEVAR, CSB and F-TEVAR are all safe and effective methods, and F-TEVAR appears to offer equivalent clinical outcomes as a less time-consuming and minimally invasive alternative.

Comparison of techniques for left subclavian artery preservation during thoracic endovascular aortic repair: A systematic review and single-arm meta-analysis of both endovascular and surgical revascularization

“…There are two types of fenestration techniques, pre-fenestration and in situ fenestration, each of which may be appropriate in certain clinical situations. In the current meta-analysis, all the cases in other studies except two were totally complemented in situ fenestration technique ( 26 , 46 ). An increasing number of studies have described the high repeatability and low perioperative mortality and morbidity of this procedure ( 25 , 57 , 58 ).…”

“…After screening titles and abstracts, 24 case reports, 17 reviews and 134 publications that did not meet the inclusion criteria were excluded. All remaining 39 studies were retrieved for full text, of which 28 articles were finally included for the analysis ( 19 – 46 ). The screening procedure for this review is depicted in Figure 1 .…”

“…Another advantage of ER is the shorter surgical time requirement as compared to open surgery ( 46 ). When performing ER, the stent-graft is also more tolerant of DSA imaging accuracy and proficiency of manipulation ( 52 ).…”

Application of left common carotid-left subclavian artery shunt for reconstruction of left subclavian artery in TEVAR of type B aortic dissection with insufficient proximal anchoring area: 10 years of single-center experience

“…However, preoperative imaging of the cerebral anatomy is not routinely performed. All patients underwent TEVAR and LSA revascularization [4] . In the first stage of the procedure, all patients underwent an LCCA-LSA shunt (including bypass(Fig.…”

Experience with the Ankura Thoracic Stent Graft and In-situ Fenestration for the Left Subclavian Artery with the Fu-Through Needle - a Technical Overview and Comparison to Similar Endovascular Techniques

“…The procedure has also been associated with low rates of mortality, stroke, and renal failure. Long-term outcomes are missing, with studies reporting low rates of aneurysmrelated mortality and reintervention [8,9].…”