Left Subclavian Artery - Does It Need Attention During TEVAR For Blunt Traumatic Aortic Injury

Abstract

Introduction: Endovascular treatment for Blunt Thoracic Aortic Injury is currently an emerging alternative as compared to traditional open repair due to superior outcomes in terms of mortality and morbidity. However, the decision to revascularize the left subclavian artery remains controversial in cases requiring the coverage of the left subclavian artery. We report our experience with endovascular stent-graft repair for blunt traumatic thoracic aorta injury. Methods: Medical records from 11 patients who underwent Thoracic Endovascular Aortic Repair (TEVAR) for Blunt Thoracic Aortic Injury (BTAI) between January 2017 to April 2019 were analysed Results: Among the 11 patients who sustained BTAI, 10 of them have been caused by motor vehicle accidents with the exception of 1 patient who sustained a fall from height. The mean Injury Severity Score is 32.72. Time elapsed between injury and TEVAR ranged between 13 hours and 321.17 hours with a mean of 73.47 hours and a median of 31.5 hours. Technical success rate was 100%. The left subclavian artery (LSA) was covered in 6 patients while the rest had partially covered LSA to achieve adequate proximal landing zone. None of our patients had experience upper limb ischaemia. Two patients developed a cerebrovascular accident, while a Type 1a endo-leak was seen in 1 patient. One patient underwent revascularization of the LSA due to atretic right vertebral artery. The mortality rate was (2/11) however the deaths were unrelated to TEVAR. Mean follow up was 8.88 months with a range of 1 to 23 months. Conclusions: We concluded that TEVAR is a safe and viable option to treat blunt thoracic aortic repair within our inherently young patient sample. LSA could be safely covered in TEVAR without preoperative revascularization as long as of contraindications such as atretic right vertebral artery or aberrations of the left vertebral artery anatomy are ruled out in preoperative CT angiogram.