Outcome of Revascularizing the Left Subclavian Artery via Carotid-Subclavian Bypass

Abstract

Background Endovascular thoracic aortic treatment frequently requires extending the proximal landing zone up into the aortic arch with consecutive covering of the left subclavian artery orifice. Our aim was to report on our outcome of left subclavian artery revascularization using carotid-subclavian bypass via lateral access to the subclavian artery. Methods Patients' charts in our aortic center were screened for all those who had undergone carotid-subclavian bypass during endovascular thoracic aortic repair procedures. We analyzed perioperative complications such as cervical plexus nerve or phrenic nerve injury, bleeding, and primary and follow-up graft patency. Results Between 2001 and 2020, 118 patients underwent carotid-subclavian bypass implantation. Postoperative complications included left-sided stroke in 3% and axillary, phrenic, and recurrent laryngeal nerve palsy in 3, 2, and 3%, respectively. Carotid-subclavian bypass–related death rate was 0%. Bypass patency was 92 ± 7% at 5 years. We documented nine (8%) bypass late occlusions with one left upper extremity ischemia and one late stroke due to an embolized thrombus formed at the bypass anastomosis. All others were asymptomatic. Conclusion Carotid-subclavian bypass surgery is associated with very low risk of death, stroke, or any nerve palsy. Lateral access to the left subclavian artery reduces the risk of phrenic nerve injury.

Anatomic Feasibility of In-Situ Fenestration for Isolate Left Subclavian Artery Preservation during Thoracic Endovascular Aortic Repair Using an Adjustable Needle Puncturing System

“…Recent meta-analyses demonstrated that revascularization of the LSA is associated with decreased risks of cerebrovascular accidents, spinal cord ischemia (SCI), and left upper limb ischemia but at the cost of worrying local complications [ 3 , 4 , 5 ]. Different alternative endovascular solutions, such as the parallel grafts techniques, customized fenestrated or scalloped or branched endograft, have been designed to challenge left carotid-LSA bypass or transposition [ 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. Among total endovascular solutions, the former are versatile but have inconsistent durability, while the latter offer encouraging results but are complex procedures and require long manufacturing time.…”