Management of the Left Subclavian Artery during Endovascular Stent Grafting for Traumatic Aortic Injury – A Systematic Review

Sepehripour, Amir H.; Ahmed, Kamran; Vecht, Joshua A.; Anagnostakou, Vania; Suliman, Amna; Ashrafian, Hutan; Darzi, Ara; Athanasiou, Thanos

doi:10.1016/j.ejvs.2011.01.007

Cited by 34 publications

(14 citation statements)

References 109 publications

(17 reference statements)

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“…That was largely because the tear in the proximal descending aorta was covered by stent graft, and complete thrombosis thereby formed in the false lumen of the descending aorta, preventing the continuous blood perfusion from oozing into the false lumen. Moreover, in our study, stroke and left limb ischemia did not develop during follow-up, likely as a result of performing fenestration at the LSA instead of LSA ligation or coverage, which have been associated with a high incidence of left limb ischemia (between 4.1% and 10.2%) and potential neurologic complication [12][13][14][15].…”

Section: Commentmentioning

confidence: 58%

Left Subclavian Artery Fenestration: A Novel Treatment Strategy for Acute Type A Aortic Dissection

Tang

Liao

Han

et al. 2016

The Annals of Thoracic Surgery

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Section: Commentmentioning

confidence: 58%

Left Subclavian Artery Fenestration: A Novel Treatment Strategy for Acute Type A Aortic Dissection

Tang

Liao

Han

et al. 2016

The Annals of Thoracic Surgery

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“…The minimum length of the normal proximal landing zone required to perform endovascular repair without LSA coverage is about 1.5 to 2 cm. In BTAI, the incidence of LSA coverage is 25%, and this results in a perioperative stroke rate of 1.19% and an arm ischemia rate of 4.06%, but it does not show a significant difference in mortality [22]. Of our patients, 37.5% (3/8) required coverage, and there was no neurologic deficit during the follow-up period.…”

Section: Discussionmentioning

confidence: 99%

Traumatic Aortic Injury: Single-center Comparison of Open versus Endovascular Repair

Cho

Kwon

Lee

et al. 2012

Korean J Thorac Cardiovasc Surg

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BackgroundConventional open repair is a suboptimal therapy for blunt traumatic aortic injury (BTAI) due to the high postoperative mortality and morbidity rates. Recent advances in the thoracic endovascular repair technique may improve outcomes so that it becomes an attractive therapeutic option.Materials and MethodsFrom August 2003 to March 2012, 21 patients (mean age, 45.81 years) with BTAI were admitted to our institution. Of these, 18 cases (open repair in 11 patients and endovascular repair in 7 patients) were retrospectively reviewed and the early perioperative results of the two groups were compared.ResultsAlthough not statistically significant, there was a trend toward the reduction of mortality in the endovascular repair group (18.2% vs. 0%). There were no cases of paraplegia or endoleak. Statistically significant reductions in heparin dosage, blood loss, and transfusion amounts during the operations and in procedure duration were observed.ConclusionCompared with open repair, endovascular repair can be performed with favorable mortality and morbidity rates. However, relatively younger patients who have acute aortic arch angulation and a small aortic diameter may be a therapeutic challenge. Improvements in graft design, delivery sheaths, and graft durability are the cornerstone of successful endovascular repair.

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“…Although infrequent, acute upper extremity ischaemia has also been reported in the setting of LSA coverage [18]. However, such risks may be justified, especially in emergency situations in order to prevent mentioned endoleakage.…”

Section: Discussionmentioning

confidence: 99%

Thoracic endovascular aortic repair with left subclavian artery coverage without prophylactic revascularisation—early and midterm results

Wojciechowski

Znaniecki

Bury

et al. 2014

Langenbecks Arch Surg

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BackgroundThe management of the left subclavian artery when coverage is necessary during thoracic aorta endografting remains a matter of debate.Materials and methodsA retrospective analysis of a single-centre experience with thoracic endovascular aorta repair (TEVAR) was performed. Between April 2004 and October 2012, 125 cases of TEVAR were performed. The analysis focused on patients who required coverage of the left subclavian artery (LSA). We analysed mortality and morbidity with special attention to the rates of cerebrovascular accidents (CVAs) and spinal cord ischaemia (SCI) in the early and midterm.ResultsOf the 125 patients, 53 (42 %, group A) required an intentional coverage of the LSA to obtain an adequate proximal seal for the endograft; the remaining patients constituted group B. None of the patients in group A had protective LSA revascularisation prior to TEVAR. The primary technical success rate was 79.2 vs. 90.3 % (group A vs. group B, p = 0.08), and the primary clinical success rate was 77.4 vs. 82 % (group A vs. group B, p = 0.53). The 30-day mortality rate was 11.3 vs. 11.1 % (group A vs. group B, p = 0.97). The 30-day morbidity was 7.5 vs. 13.9 % (group A vs. group B, p = 0.4). CVA occurred in 1.9 % of group A patients, compared to 1.4 % of patients from group B (p = 0.82). The SCI incidence rate was 0 vs. 1.4 % (p = 0.39). The mean follow-up of group A was 24.1 months (range 2–64.6 months, SD = 19). Additionally, the 1-year estimated survival was 85.5 %, and the 3-year estimated survival was 78 %. There were no midterm CVAs; one event of SCI occurred in the seventh post-operative month in group A.ConclusionOur analysis, although retrospective and based on one institution experience, shows a realistic population of TEVAR patients. We prove that TEVAR with coverage of LSA origin can be accomplished with minimal neurological morbidity in this patient population. The study shows that LSA revascularisation is not mandatory before endograft deployment, especially in emergency settings. We also prove that although zone 2 TEVAR extends the proximal landing zone, it does not prevent type IA endoleaks from appearing. A multicentre randomised control trial with higher number of patients is necessary for proper, robust conclusion to be established.

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Management of the Left Subclavian Artery during Endovascular Stent Grafting for Traumatic Aortic Injury – A Systematic Review

Cited by 34 publications

References 109 publications

Left Subclavian Artery Fenestration: A Novel Treatment Strategy for Acute Type A Aortic Dissection

Left Subclavian Artery Fenestration: A Novel Treatment Strategy for Acute Type A Aortic Dissection

Traumatic Aortic Injury: Single-center Comparison of Open versus Endovascular Repair

Thoracic endovascular aortic repair with left subclavian artery coverage without prophylactic revascularisation—early and midterm results

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