Procedure selection of left subclavian artery revascularization in thoracic endovascular aortic repair

Abstract

In order to require ideal proximal landing zone and durable long-term outcome, it is necessary to reconstruct the left subclavian artery(LSA) blood supply as much as possible in thoracic aortic endovascular repair(TEVAR). With the advent and progress of diverse assisted techniques and devices, several procedures for the reconstruction of the left subclavian artery have been developed and widely utilized, including surgical LSA bypass or transposition, chimney technique, periscope technique, fenestration and branched stent-graft, which have expanded the proximal landing zone and widened the indication for original TEVAR. This article describes the advantages and pitfalls of each revascularization methods. Anatomies of aortic arch and LSA, urgency and types of pathologies, proficiency of the surgeon with different revascularization techniques and pre-operative risk score of patient should be evaluated in procedure selection. In clinical application, patient-specific evaluations and individualized considerations are essential for initialize the therapeutic strategy and decision making.