Intentional Occlusion of the Left Subclavian Artery during Endovascular Repair of Descending Thoracic Aorta

Abstract

SUMMARY The safety and efficacy of endovascular repair of descending thoracic aorta depends on certain anatomical conditions, in particular the presence of a healthy segment of the aorta (proximal neck). In a significant proportion of patients, the proximal neck is inadequate or non-existent. A bypass or transposition of the left subclavian artery would maintain an adequate perfusion of the left arm after stent-graft implantation. However, this surgical approach is not always feasible in unstable patients who are treated urgently or that have multiple comorbidities. Objective Evaluate the clinical and neurological consequences of intentional occlusion of the left subclavian artery during endovascular repair of descending thoracic aorta. Material and Methods Between August 1999 and February 2010, 136 patients were consecutively treated with implantation of self-expandable stent-grafts. In 29 patients (21%) with absence of an adequate proximal neck (healthy aorta sector ≥ 15mm in length), it had to be intentionally covered the origin of the left subclavian artery. In all cases, before procedure it was carried out a selective angiography of the right vertebral artery in order to confirm the permeability of this and the conformation of the vertebrobasilar circulation. Background