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.

Keywords

aorta - subclavian artery - carotid artery - aneurysm - dissection - endovascular aortic repair

Publikationsverlauf

Eingereicht: 26. November 2022

Angenommen: 14. April 2023

Artikel online veröffentlicht:
31. Mai 2023

• References

• 1 Czerny M, Schmidli J, Adler S. et al; EACTS/ESVS scientific document group. Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS). Eur J Cardiothorac Surg 2019; 55 (01) 133-162
• 2 Jing Z, Lu Q, Feng J. et al. Endovascular repair of aortic dissection involving the left subclavian artery by Castor stent graft: a multicentre prospective trial. Eur J Vasc Endovasc Surg 2020; 60 (06) 854-861
• 3 Roselli EE, Arko III FR, Thompson MM. Valiant Mona LSA Trial Investigators. Results of the Valiant Mona LSA early feasibility study for descending thoracic aneurysms. J Vasc Surg 2015; 62 (06) 1465-71.e3
• 4 Luehr M, Etz CD, Berezowski M. et al. Outcomes after thoracic endovascular aortic repair with overstenting of the left subclavian artery. Ann Thorac Surg 2019; 107 (05) 1372-1379
• 5 Lee TC, Andersen ND, Williams JB, Bhattacharya SD, McCann RL, Hughes GC. Results with a selective revascularization strategy for left subclavian artery coverage during thoracic endovascular aortic repair. Ann Thorac Surg 2011; 92 (01) 97-102 , discussion 102–103
• 6 Voigt SL, Bishawi M, Ranney D, Yerokun B, McCann RL, Hughes GC. Outcomes of carotid-subclavian bypass performed in the setting of thoracic endovascular aortic repair. J Vasc Surg 2019; 69 (03) 701-709
• 7 Hajibandeh S, Hajibandeh S, Antoniou SA, Torella F, Antoniou GA. Meta-analysis of left subclavian artery coverage with and without revascularization in thoracic endovascular aortic repair. J Endovasc Ther 2016; 23 (04) 634-641
• 8 Protack CD, Smith A, Moennich LA, Hardy D, Lyden SP, Farivar BS. Midterm outcomes of subclavian artery revascularization in the setting of thoracic endovascular aortic repair. J Vasc Surg 2020; 72 (04) 1222-1228
• 9 Konstantinou N, Debus ES, Vermeulen CFW. et al. Cervical debranching in the endovascular era: a single centre experience. Eur J Vasc Endovasc Surg 2019; 58 (01) 34-40
• 10 Rylski B, Schofer F, Beyersdorf F. et al. Aortic arch anatomy in candidates for aortic arch repair. Semin Thorac Cardiovasc Surg 2022; 34 (01) 19-26
• 11 Bianco V, Sultan I, Kilic A. et al. Concomitant left subclavian artery revascularization with carotid-subclavian transposition during zone 2 thoracic endovascular aortic repair. J Thorac Cardiovasc Surg 2020; 159 (04) 1222-1227