Abstract
This study was to analyze the outcomes of left subclavian artery (LSA) revascularization during thoracic endovascular repair (TEVAR) for type B aortic dissections (TBAD). From 2011 to 2017, TBAD patients who underwent LSA revascularization during TEVAR were enrolled. Technical success, endoleaks, mortality, complication, reintervention, and patency of target vessels were analyzed. 38 patients were included, 14 underwent carotid-subclavian bypass (CSB), and 24 underwent chimney graft (CG) implantation. Technical success rates were 92.9% and 100% in CSB and CG group. Eleven immediate type I endoleak (EL-I) was detected, including one from CSB group and ten from CG group. Three immediate type II endoleak (EL-II) was detected in CSB group. Perioperative complications showed no difference, but CSB group had longer intensive care unit (ICU) stay time. Median follow-up time was 26.2 months, and overall mortality was 14.3% and 0% in each group. Three EL-I and one EL-II underwent reintervention. All the LSA showed good patency, except one suffered from CG collapse. Both CSB and CG were feasible strategies to preserve the antegrade blood flow of LSA, and each strategy had its advantages and disadvantages. Based on our current experience, we preferred CG for high-risk patients. However, the evidence was still not strong enough, further well-designed studies are necessary to identify the criteria for LSA revascularization strategy during TEVAR.
Highlights
For Stanford type B aortic dissection (TBAD), the thoracic endovascular aortic repair (TEVAR) had demonstrated favorable short- and mid-term results[1,2]
Intentional coverage of left subclavian artery (LSA) might not be physiologically tolerated because the LSA provides extensive circulation to the left upper limb, spinal cord and posterior cerebral circulation
A few of studies had reported their clinical outcomes on LSA revascularization during thoracic endovascular repair (TEVAR), most of them only reported carotid-subclavian bypass (CSB) or chimney graft (CG), no comparison had been made between these two strategies
Summary
For Stanford type B aortic dissection (TBAD), the thoracic endovascular aortic repair (TEVAR) had demonstrated favorable short- and mid-term results[1,2]. It had its limitations, one of which was the necessity of an adequate, disease-free proximal seal zones for the aortic stent graft. The recommendations were based on low-quality evidence and did not address which revascularization strategy would be better during TEVAR for TBAD4. We shared our experiences in LSA revascularization by carotid-subclavian bypass (CSB) and chimney graft (CG), and analyzed the outcomes of these two strategies during TEVAR for TBAD
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