CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2018; 02(03): S2-S3
DOI: 10.1055/s-0041-1730650

Management of the Left Subclavian Artery with Thoracic Endovascular Aortic Repair

Sid Ahmed Benaroussi
Department of Vascular and Endovascular Surgery, Hospital University Establishment, Oran, Algeria
Mohamed Najib Bouayed
Department of Vascular and Endovascular Surgery, Hospital University Establishment, Oran, Algeria
› Author Affiliations

Background: The thoracic endovascular aortic repair (TEVAR) for aortic aneurysm and dissection has shown it superiority to open surgery. In 26%–40% of patients, the proximal sealing zone beyond the left subclavian artery (LSA) had inadequate length that led to LSA coverage. The practice guidelines in this situation to decide about the revascularization are based on low-quality evidence, and there is limited literature that guides us to optimal revascularization techniques. The purpose of this study was to compare outcomes of LSA coverage during TEVAR without and with revascularization using different surgical techniques. Methods: We performed a single-center retrospective cohort study of 80 patients who underwent TEVAR from 2008 to 2017. The LSA was covered to obtain an adequate proximal landing zone, and a selective LSA revascularization by subclavian-carotid transposition and chimney technique was employed. Stroke, spinal cord ischemia, upper extremity ischemia, vertebrobasilar insufficiency, primary patency of revascularization, and nerve injury were compared. Results: The origin of the LSA was covered in 11/80 patients and revascularization in 10/80 patients. Median follow-up was 46 months in the covered group and 36 months in revascularized group. There were no major complications in LSA covered group and only some local complications in revascularized group; however, we observe some endoleak in patients treated by chimney technique who needed reintervention. Conclusion: The theoretical risks of the LSA coverage without revascularization are not constant. However, the revascularization is not free of complications and requires a trained team. The chimney technique had to be improved to get a good result and it also requires a randomized study.

Publication History

Article published online:
11 May 2021

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