Perioperative Outcomes of Carotid–Subclavian Bypass or Transposition versus Endovascular Techniques for Left Subclavian Artery Revascularization during Nontraumatic Zone 2 Thoracic Endovascular Aortic Repair in the Vascular Quality Initiative

D’Oria, Mario; Kärkkäinen, Jussi M.; Tenorio, Emanuel R.; Oderich, Gustavo S.; Mendes, Bernardo C.; Shuja, Fahad; Colglazier, Jill J.; DeMartino, Randall R.

doi:10.1016/j.avsg.2020.05.062

Cited by 35 publications

(19 citation statements)

References 33 publications

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“…However, plenty of time used for markers increased the burden of patients. According to the previous studies about handmade fenestration for the LSCA, the mean operation time was 171–176 min, which was significantly longer than our data (mean operation time, 125 min) ( 22 , 23 ).…”

Section: Discussioncontrasting

confidence: 75%

The Mini-Cross Prefenestration for Endovascular Repair of Aortic Arch Pathologies

Pei¹,

Zhu²,

Xiao³

et al. 2022

Front. Cardiovasc. Med.

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Objective: To examine the feasibility, integrity, efficacy, and safety of endovascular repair of the aortic arch pathologies with the mini-cross prefenestration (MCPF) on stent grafts.Methods: First, to prove the feasibility of the MCPF, an in-vitro prefenestration experiment was conducted. Second, to examine the integrity of the MCPF stent grafts, a fatigue test was conducted. Then, the membranes and metal structures of stent grafts were examined by light microscopy and scanning electron microscopy (SEM). Third, a clinical experiment was conducted to investigate the efficacy and safety of this novel technique (ClinicalTrials.gov Identifier: NCT04544579).Results: All the 12 branch stents were successfully implanted and flared in vitro. After the fatigue test stimulating a 5-year cardiac cycle, no obvious disintegration or fracture was found in light microscopy or SEM. From December 2017 to February 2020, 26 patients with left subclavian arteries and/or left common carotid arteries involved received the novel technique. The endovascular repair with the MCPF was successfully performed on all the 26 (100%) patients. Eighteen (69.2%) patients underwent the reconstruction of the left subclavian artery (LSCA) only. The fenestrations of both the LSCA and left common carotid artery (LCCA) were conducted in 8 (30.8%) patients. Median operative time was 120 [interquartile range (IQR), 95–137.5] min and median revascularization time of the LSCA and LCCA was 30.5 (IQR, 22.8–42.0) s and 20.0 (IQR, 18.0–32.0) s separately. During the median follow-up duration of 38.9 (range, 18.8–44.2) months, one case needed an open surgery because of retrograde type A aortic dissection 3 months after implantation and no other complications or mortality occurred. The maximum aortic diameters were significantly decreased in patients with thoracic aortic dissection and thoracic aortic aneurysm (p < 0.05).Conclusion: The existing evidence demonstrated the safety, rapid branch artery revascularization, and positive aortic remodeling of the novel technique. Long-term observation is warranted to prove the durability.

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Section: Discussioncontrasting

confidence: 75%

The Mini-Cross Prefenestration for Endovascular Repair of Aortic Arch Pathologies

Pei¹,

Zhu²,

Xiao³

et al. 2022

Front. Cardiovasc. Med.

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“…Main findings of this study included significantly higher technical and clinical success and lower type I Perioperative outcomes of open (n = 721) and endovascular LSA debranching (n = 116) were recently compared using prospectively collected registry data from the Vascular Quality Initiative, but only 20% (n = 23) of endovascularly treated patients received parallel grafts. 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][16][17] Table 4 demonstrates their results along with studies that examined either open or parallel graft-based LSA debranching only.…”

Section: Discussionmentioning

confidence: 99%

“…3,5) Open LSA debranching procedures involve left carotid-axillary or -subclavian bypasses as well as subclavian-carotid-transposition enabling hybrid arch repair without opening the thoracic cavity. 2,4,6) Especially, carotid-subclavian bypasses have widely been used for LSA debranching with excellent long-term patency but require general anesthesia and may cause nerve, lymphatic, or bleeding complications and stroke. 4) On the other hand, the use of minimally invasive parallel grafts for LSA debranching has meanwhile been confirmed as one promising endovascular option for zone 2 TEVAR in several clinical studies.…”

Section: Introductionmentioning

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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“…In our cohort, 30-day and midterm complications appeared to occur more commonly in CSB, but this difference was not statistically significant. It also might be argued that the additional open procedure might cause extra complications (particular local bleeding, nerve palsy, graft infection and lymphatic leak) [ 19 , 20 ], while a totally endovascular approach to LSA revascularization would theoretically not be subject to these complications and would maintain the minimally invasive nature of TEVAR [ 21 ]. In our study, all patients underwent LSA fenestration during TEVAR were scheduled for elective surgery.…”

Section: Discussionmentioning

confidence: 99%

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

Xie

Xue

et al. 2021

J Cardiothorac Surg

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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.

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Perioperative Outcomes of Carotid–Subclavian Bypass or Transposition versus Endovascular Techniques for Left Subclavian Artery Revascularization during Nontraumatic Zone 2 Thoracic Endovascular Aortic Repair in the Vascular Quality Initiative

Cited by 35 publications

References 33 publications

The Mini-Cross Prefenestration for Endovascular Repair of Aortic Arch Pathologies

The Mini-Cross Prefenestration for Endovascular Repair of Aortic Arch Pathologies

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

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

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