Subclavian Artery Research Articles

Exsanguination Following Iatrogenic Subclavian Artery Injury: A Surgical Rescue

Exsanguination Following Iatrogenic Subclavian Artery Injury: A Surgical Rescue

Submucosal hemorrhage of the esophagus: a case report.

Submucosal hemorrhage of the esophagus is relatively rare and the course of this disease remains unclear. We report a case of this disease. The patient was a 68-year-old man who visited a clinic complaining of sudden-onset epigastric and back pain. He had been taking warfarin and a statin due to non-obstructive hypertrophic cardiomyopathy, right subclavian artery stenosis, and chronic atrial fibrillation. Contrast-enhanced computed tomography showed esophageal submucosal hemorrhage. Detailed endoscopic examination was difficult because of the massive hemorrhage and progressive esophageal mucosal edema. He was transferred to our hospital due to progression of anemia. Fortunately, hemorrhagic anemia showed no progression with conservative fasting therapy after admission to our hospital. Esophageal mucosa over the submucosal hemorrhage detached and regenerative tissue was observed on endoscopic examination 1week later. Esophageal submucosal hemorrhage should be included among the differential diagnoses for patients presenting with chest and back pain.

MS O10 - BN Case Report: Aberrant Right Subclavian Artery As A Rare Differential For Dysphagia

Abstract Background Dysphagia lusoria (DL) is characterised by swallowing difficulty due to external oesophageal compression from congenital aortic arch malformations. It is clinically rare and affects less than 2.5% of the population. The most prevalent form of DL is the aberrant right subclavian artery (ARSA) where approximately 10% of patients experience dysphagia. Despite AL being congenital, dysphagia often manifests later in life, likely due to age-related atherosclerotic changes in the vasculature and decreased oesophageal flexibility. Method Presented is a case report of a female in her seventies where, despite repeat hiatal hernia repair and maximal medical management, her index symptoms of dyspepsia and retrosternal discomfort persisted when reviewed in specialist upper gastrointestinal clinic. She underwent extensive investigation; however, her symptoms were unremitting, manifesting in numerous emergency department presentations to exclude acute coronary syndrome. This case report details the anatomical differences via diagrams and documents the comprehensive investigation and multi-disciplinary approach to the management of dysphagia in ARSA. Results Prior to referral to our team, the patient had a laparoscopic hiatus hernia repair and Nissen fundoplication undertaken. Oesophageal manometry revealed weak oesophageal motility and 24-hour pH monitoring did not demonstrate pathological acid-reflux. Recurrence of hiatus hernia was observed on oral contrast swallow and gastroscopy. Subsequently, the patient underwent laparoscopic revision of hiatus hernia and conversion of Nissen to a Dor. Post-operatively her symptoms required complete fundoplication reversal. Following reversal, assessment demonstrated improved distal oesophageal emptying. Her CT emphasised an ARSA causing significant compression and deviation of the proximal oesophagus. The patient was referred onwards to vascular surgery. Conclusion Initial diagnostic workup for patients presenting with dysphagia in the upper gastrointestinal clinic seeks to encompass several common aetiologies including oesophageal motility disorders, malignant compression and benign strictures. Clinicians must consider less common causes of extrinsic compression, such as ARSA, particularly in patients with unrelenting and persistent symptoms despite appropriate implementation of both medical and surgical interventions. Treatment approaches for ARSA reflect symptom severity, with both conservative and surgical options considered.

Artifactual Subclavian Artery Thrombosis on CTA With Iterative Metal Artifact Reduction.

Artifactual Subclavian Artery Thrombosis on CTA With Iterative Metal Artifact Reduction.

Abstract 4134841: A Diagnostic Pitfall: Subclavian Stenosis Mimicking Severe Aortic Stenosis on Echocardiography"

Background: Aortic stenosis (AS) is a common and serious valve disease in the elderly, often diagnosed using echocardiography. However, certain conditions can mimic AS, leading to diagnostic challenges. This case highlights the importance of a comprehensive vascular assessment in patients with atypical symptoms and echocardiographic findings suggestive of severe AS. Case Presentation: An 80-year-old female presented with progressive dizziness and double vision over the past few months. She reported a long-standing history of lower blood pressure in her right arm compared to her left. Her medical history was significant for HER2-positive intraductal breast cancer treated with neoadjuvant chemotherapy. An echocardiogram performed two months prior to presentation, using a Pedoff probe, indicated severe AS with a peak systolic velocity of 5.1 m/sec, a mean systolic gradient of 50 mm Hg, and an aortic valve area of 0.6 cm. Investigations: Given the discrepancy in blood pressure between her arms and the wide open aortic valve on the echo which dosen't corrleate with the doppler numbers, CTA neck and chest was performed, revealing a dense calcific plaque causing severe stenosis at the origin of the left subclavian artery. An angiogram confirmed >75% stenosis of the left subclavian artery, which was treated with angioplasty and stent placement, resulting in <10% residual stenosis. Outcome: Following the intervention, a repeat echocardiogram showed only mild calcification of the aortic valve with a mean gradient of 4 mm Hg, significantly lower than the previous findings. Discussion: This case underscores the potential for subclavian artery stenosis to mimic severe AS on echocardiography, particularly when using the Pedhoff probe. It highlights the need for clinicians to consider vascular anomalies in the differential diagnosis when echocardiographic doppler findings do not correlate with clinical symptoms or with the structural apperance of the valves. Conclusion: Comprehensive assessment and consideration of alternative diagnoses are crucial in patients with suspected severe AS, especially when using Doppler echocardiography. Awareness of the potential for subclavian artery stenosis to cause false-positive echocardiographic findings can prevent unnecessary interventions and guide appropriate management.

Abstract 4118076: Right Innominate Artery Endovascular Intervention Via Single Radial Access and Use Of Embolic Protection

Introduction: The occurrence of innominate artery stenosis is less prevalent compared to subclavian artery disease. Small studies suggest up to 8% of individuals initially diagnosed with suspected subclavian steal syndrome may present with innominate artery lesions. Deployment of an embolic protection filter within the internal carotid artery during percutaneous intervention of the innominate artery presents a solution to mitigate embolism. Case: A 70-year-old female with a history of peripheral vascular disease presented with claudication in both arms, manifested as pain in both arms. Her left subclavian was stented months prior to presentation. An aortogram revealed severe stenosis of the innominate artery (Figure 1). Since multiple attempts to cross the lesion antegrade from the femoral access site were unsuccessful, we proceeded with the successful deployment of an embolic protection filter in the right internal carotid artery via our right radial artery access site (Figure 2). Using the right radial artery, we passed a long run-through guidewire into the distal abdominal aorta. Due to severe aortic tortuosity, we were unable to snare the wire from the aorta. Therefore, we upsized the radial sheath to 7 French over both wires (runthrough and bare). Using a support catheter, we exchanged the runthrough wire for a Glidewire Advantage. We advanced an 8 x 29mm balloon expandable stent to the area of innominate stenosis and deployed it (Figure 3). We postdilated the stent with a 14mm balloon. Angiography demonstrated adequate expansion. On follow up, the patient was without claudication and had triphasic flow in the innominate and left subclavian arteries. Discussion: Treating innominate artery stenosis via radial access employing a sole entry point for both embolic protection and treatment administration offers a substitute where additional access is infeasible. Modern embolic protection techniques are superior due to their flexibility and ease of use. In this case, placing the embolic protection device in the carotid artery was mandatory through the sole radial access to prevent trapping the filter behind the innominate artery stent. We were able to perform both the embolic device placement and the stenting with the same radial access. Conclusion: Endovascular intervention of innominate artery stenosis via radial access, utilizing a single radial access for both embolic protection and treatment delivery, presents an alternative when femoral access is not feasible.

Abstract 4138322: Do branched stent grafts for dissecting aortic aneurysms really improve long-term outcomes?

Backgrounds: We have previously used a handmade branched stent graft (SG) to treat thoracic aortic aneurysms. In this study, we examined the long-term results of treatment for dissecting thoracic aortic aneurysms. Methods: Between 2004 and 2014, we treated 28 patients with dissecting thoracic aneurysms using the branched SGs. Results: The mean age was 65 ± 14 years; 17 were over 70, and 22 were male. The mean time from the onset of dissection was 5.7 ± 6.3 years; 6 were operated within one year. The mean aneurysm diameter was 59 ± 8 mm. All dissecting aneurysms were located after zone 3. SG branches were one in 24 cases, two in 2, and three in 2. Twenty-two were treated for entry closure and distal landing in the true lumen. Six with limited dissecting aneurysms were treated for entry closure and distal landing in a non-dissected lumen. The cause of perioperative death was pneumonia in 1. The mean follow-up was 8.3 ± 5.3 years. Entry closure was achieved at 86%, branch patency was 94%, and aneurysm diameter was reduced by an average of 5 ± 14%. There were 6 aneurysm-related deaths. Two were aneurysm ruptures, and each of the 4 was additional operative death, sudden death, SMA occlusion, and type A dissection. The aneurysm-related mortality was 26% at eight years; there was no difference between under 70 and over 70 years old. The cumulative risk of additional procedures was 57% at eight years, and the risk was higher in those over 70 than those under 70 (p<0.05). Thirteen required additional procedures, and 5 required multiple. In detail, re-TEVAR to distal SINE was in 7, re-TEVAR for aneurysm enlargement due to residual false lumen was in 1, re-TEVAR for type 1a endoleak (EL) was in 4, open repair was in 3, stenting for stenosis of true lumen in iliac artery was in 1, stenting for SG branches were in 2, and embolization of the left subclavian artery after re-TEVAR was in 1. Details of open repair were partial arch and thoracic descending replacement for type 1a EL in 1, ascending and partial arch replacement for type 1a EL followed by partial arch and thoracoabdominal replacement in 1, partial arch and thoracoabdominal replacement for distal SINE and aneurysm enlargement in 1. Conclusion: The branched SG for dissecting thoracic aneurysms successfully achieved the initial goal of entry closure, which concept is promising, but requires careful observation for appropriate additional procedures.

Hybrid Thoracic Endovascular Repair of a Large, Saccular Aortic Arch Aneurysm with Coil Embolization of the Left Subclavian Artery in a 31 Year Old Filipino Female with Takayasu Arteritis and Multiple Intracranial Aneurysms: A First in the Philippines

BACKGROUND: Takayasu Arteritis (TA) is a rare, primary large-vessel vasculitis frequently leading to stenosis and less commonly, aneurysm formation. Saccular aneurysms of the aortic arch in patients with TA are fatal, have rarely been reported and represent a significant technical challenge due to the difficult anatomical location and need for protection of the cerebral circulation. Concomitant intracerebral aneurysms in patients with TA are extremely uncommon and have mostly been documented in very few case reports in literature. CASE DISCUSSION: We present a case of a 31 year-old Filipino female with recurrent chest and neck pain radiating to the upper back. Computed tomographic (CT) angiography demonstrated a large saccular aortic arch aneurysm without branch stenosis. CTA of the cerebral circulation likewise demonstrated multiple, saccular, intra-cerebral aneurysms. She underwent hybrid thoracic arch repair with supra-aortic debranching via mini-sternotomy and proximal ligation of the left common carotid artery and staged endovascular aortic arch replacement with coil embolization of the ostial-to-proximal left subclavian artery segment. Post-operative aortogram showed optimal repair with thrombosed aneurysmal sac, optimal graft position, no endoleaks and preservation of cerebral circulation. Patient improved symptomatically post-procedure and remained symptom-free during follow-up after six months. Careful review of local literature suggests that this is the first Philippine TA case with a saccular aortic arch aneurysm successfully managed in this manner. CONCLUSION: Saccular aortic arch aneurysms in patients with Takayasu are unusual and presence of concomitant multiple cerebral saccular aneurysms have rarely been reported in literature. This case highlighted that hybrid endovascular arch repair in patients with TA is feasible, minimally invasive and effective. KEYWORDS: Takayasu arteritis, aortic arch aneurysm, cerebral aneurysm, hybrid endovascular arch repair, aortic de-branching

Obscure Rare Cause of Recurrent Angina in Post CABG Patient: Coronary-Subclavian Steal Syndrome

Coronary subclavian steal syndrome (CSSS) is a rare and unrecognized complication of coronary bypass grafting surgery when a left internal mammary artery (LIMA) graft is utilized for left anterior descending (LAD) artery revascularization without knowing left subclavian artery status. We describe a case of a 67-year-old male, with a known history of triple vessel coronary artery disease (CAD) managed with CABGx3 in March 2003. The patient presented after 16 years with complaints of recurrent angina for the past 15 years which aggravates on exertion, especially of left hand. Recurrent hospitalizations and repeated Coronary angiograms (CAG) as well as CT Coronary angiography failed to diagnose the cause of angina. Subclavian angiography and subsequent methodical clinical examination during the present admission revealed left subclavian origin stenosis which was successfully revascularized by deployment of a stent resulting in convincing relief in the patient’s angina.

In situ needle fenestration for aortic arch conditions during thoracic endovascular aortic repair

BackgroundTo evaluate the clinical outcomes and the validity of the in situ needle fenestration (ISNF) technique during thoracic endovascular aortic repair (TEVAR) for patients with aortic arch conditions.MethodsA total of 115 patients with aortic arch conditions treated with ISNF during TEVAR between January 2018 and December 2021 were incorporated.ResultsThe median age of the patients was 62.0 years, and 10.4% (12/115) were female. The median follow-up time was 31.0 months. A total of 175 supra-arch branches were reconstructed. A single branch was fenestrated in 80 patients, while the left subclavian artery (LSA) and left common carotid artery (LCCA) were fenestrated simultaneously in 11 patients, and all supra-arch branches were fenestrated in 24 patients. The rate of technical success was 100%, 30-day mortality was 3.5% (4/115), overall mortality was 8.7% (10/115), and aortic-related mortality was 2.6% (3/115). Aortic-related reintervention was required in 7.8% (9/115) of patients. Among the major postoperative complications, four patients developed retrograde type A dissection requiring emergent open surgery, three patients had cerebrovascular accidents, and one patient had an endoleak. No occlusions or stenoses of the main or branch aortic stents were observed.ConclusionsThe mid-term results of the ISNF technique during TEVAR for aortic arch conditions were within the acceptable range; however, further follow-up results are needed and long-term stability and durability needs to be assessed. Related fenestration devices also require further development.

The "full rectangle" sign: a novel method for ultrasonographic diagnosis of fetal aberrant right subclavian artery.

To evaluate the feasibility and accuracy of a novel ultrasonographic screening method for an aberrant right subclavian artery (ARSA) using the novel "full rectangle" method. This prospective study was conducted at a tertiary care center, September 2022 to February 2023. The study included unselected pregnant women at 14-38weeks of gestation referred for routine or targeted anomaly scans. All participants underwent scanning by two experienced sonographers to ascertain the presence or absence of aberrant right subclavian artery (ARSA) using both conventional and novel "full rectangle sign" methods for validation purposes. This is a novel screening method for ARSA that demonstrates the retro-tracheal course at the level of the supra-aortic vessels, forming what we term the "full rectangle sign". A cohort of 138 patients was enrolled. The "full rectangle" sign was discerned in 6 fetuses with ARSA (4.3%), while the typical three-sided figure of the right subclavian artery was demonstrated in the remaining 132 fetuses (95.7%). The novel method demonstrated 100% feasibility and complete concordance with the conventional method. The study results indicate that the full rectangle sign serves as an effective and dependable screening tool for identifying ARSA. It offers the advantage of a clear, unobstructed view at a level unaffected by sternum shadowing and eliminates confusion with the azygous vein.

LVAD implantation with concomitant replacement of the ascending aorta

Dilated cardiomyopathy (DCM) is one of the main causes for end-stage heart failure. Until the transplantation, left ventricular assist devices (LVAD) have become an established treatment. We report a case of a 66-year-old patient with ischemic and dilated cardiomyopathy and suspected aortic ulcer formation. LVAD was implanted in the same session with a supracoronary aortic replacement. Bilateral cannulation of the subclavian arteries omitted the need of circulatory arrest and proximal aortic cross-clamping. Pneumonia associated decarboxylation failure prolonged the postoperative intensive care period. The patient was finally discharged home on the 115th postoperative day.

Anomalous Origin of the Right Subclavian Artery from the Right Pulmonary Artery in a Patient with d-Transposition of the Great Arteries: Diagnosis and Surgical Treatment.

Anomalous origin of the right subclavian artery (AORSA) from the right pulmonary artery is a rare congenital anomaly usually diagnosed by computed tomography, magnetic resonance imaging, or angiography. We present a very rare case of diagnosis and surgical correction of AORSA coexisting with d-transposition of the great arteries in a newborn's first hours of life. Due to the critical local hospital and patient conditions, additional cross-sectional imaging was not feasible. The diagnosis was suspected by clinical signs, confirmed by transthoracic echocardiogram, and the patient was urgently taken to the operating room. We discuss clinical and echocardiographic signs of this child with d-transposition of the great arteries and AORSA from the right pulmonary artery.

Total arterial revascularization with RIMA-LIMA-Y configuration in patients with left subclavian artery stenosis.

Subclavian artery stenosis (SAS) occurs in 6% of patients undergoing coronary artery bypass grafting (CABG). Complications such as subclavian-coronary steal are common. Revascularization options in such cases remain debatable. In this case series, all patients with angina, had severe triple vessel disease on angiography. All tests including computed tomography (CT) angiography of neck vessels, were done as part of routine workup for CABG. The patients, all males, had a mean age of 66.5 years with three of them having hypertension and diabetes. All were ex-smokers with mean ejection fraction (EF) of 60.1%. CT angiography of neck vessels revealed that two patients had moderate to severe while one had severe left SAS and another had severe proximal left internal mammary artery (LIMA) stenosis. Total arterial revascularization was performed, with an average of 3.5 distal grafts. The LIMA graft was employed in a Y graft configuration, anastomosed to in-situ right internal mammary artery (RIMA). All patients had uneventful postoperative stay and were discharged with a mean hospital stay of 3.8 days. There were no postoperative strokes, myocardial infarction, neurological symptoms, or change in EF. At 6-month follow-up, they were asymptomatic and doing well. The RIMA-LIMA-Y configuration can be a safe, viable option in CABG for patients with left SAS. It is challenging, with re-entry and judicious utilization of the length of LIMA being of paramount importance. The importance of CT angiography of neck vessels to detect SAS cannot be under-emphasized.

Rare locations of peripheral aneurysms in Marfan syndrome treated surgically: a case report

Marfan syndrome (MFS) is a connective tissue disorder that can lead to cardiovascular and musculoskeletal abnormalities. Aortic aneurysms and dissections are frequently seen in patients with MFS whereas peripheral vascular aneurysms in subclavian and axillary arteries territory considered very unusual. We reported a case of 54-year-old female with known history of MFS who had undergone a mechanical valve Bentall procedure due to severe aortic regurgitation and ascending aorta aneurysm in addition to thoracoabdominal aortic repair and who presented with a pulsatile painful mass in her right axillary region that turn to be significant true aneurysms of right subclavian and axillary arteries. To relive symptoms and to avoid further complications patient underwent successful surgical repair. Our case demonstrated rare locations of true peripheral aneurysms as a possible manifestation of MFS appeared several years post Bentall procedure and thoracoabdominal aortic repair and highlights also the importance of long-term monitoring to detect earlier such manifestation and avoid complications by surgical repair.

Current outcomes of systemic-to-pulmonary artery shunt in patients with biventricular circulation

ObjectiveThis study investigated the outcomes after systemic-to-pulmonary artery shunt (SPS) in patients with biventricular circulation. MethodsBetween January 2014 and June 2023, among 406 patients who underwent SPS, 223 patients pursuing biventricular repair were included. Primary outcome of interest was major adverse shunt-related event (MASE) which was defined as the composite of cardiopulmonary resuscitation, extracorporeal membrane oxygenation, and shunt-related intervention. ResultsThe median age and body weight were 30 days and 3.5 kg, respectively. Median ratio of shunt diameter to body weight (mm/kg) was 1.0. The origin of SPS was the subclavian artery in 118 (52.9%), and the innominate artery in 93 patients (41.7%). There were 4 early deaths (1.8%), all of which were preceded by in-hospital MASE resulting from pulmonary overcirculation. There were two interstage deaths (0.9%). Competing risk analysis showed that the probability of biventricular repair at 24 months after SPS was 94.2%. In-hospital MASE occurred in 17 patients, with most cases (n=14, 82.4%) resulting from pulmonary overcirculation. In multivariable analysis, associated genetic or extracardiac anomalies (odds ratio [OR] 4.78; p=0.019), transposition of the great arteries (OR 6.42; p=0.012) and use of cardiopulmonary bypass (OR 7.39; p=0.001) were identified as risk factors for in-hospital MASE. Among 10 cases of inter-stage MASE, 9 cases were successfully managed up to biventricular repair. ConclusionsIn the current era, SPS is a safe and useful option for patients with biventricular circulation. In patients with risk factors for in-hospital MASE, meticulous efforts should be directed towards preventing pulmonary overcirculation to further enhance outcomes.

Successful management of mycotic anastomotic pseudoaneurysm of interposition vein graft following a carotid endarterectomy: a case report

BackgroundAnastomotic pseudoaneurysms of interposition vein grafts are a rare entity that requires urgent management to prevent life-threatening complications, such as rupture and thromboembolism, especially when involving the carotid arteries. As these are rare complications and literature is sparse, we believe that this case report can aid the decision-making process in similar circumstances.Case presentationA 49-year-old Ukrainian male patient presented with a false aneurysm of both distal and proximal anastomosis of an interposition vein graft between the common carotid artery and the internal carotid artery, which was previously performed as a bailout procedure after the patient developed a complication of carotid surgery. The patient was successfully treated with extra-anatomical interposition of a vein graft from the subclavian artery to the remnant of extracranial internal carotid artery and en bloc excision of the previous vein graft with the false aneurysms.ConclusionMycotic anastomotic pseudoaneurysms following carotid endarterectomy represent a rare yet serious complication in vascular surgery that requires urgent treatment. While endovascular techniques could represent an alternative option, open surgical repair is still the standard of care for this pathology, offering advantages in preventing postoperative ischemic complications and ensuring optimal long-term outcomes. The open approach provides direct visualization of the pseudoaneurysm. It allows the meticulous debridement of the infected tissues and an accurate reconstruction of the arterial wall with autologous or synthetic grafts. In light of the substantial evidence supporting its superiority, open surgical repair should remain the preferred approach in addressing mycotic anastomotic pseudoaneurysms following carotid endarterectomy. Future research should continue to explore advancements in other surgical techniques and refine treatment strategies to enhance patient outcomes in this challenging clinical scenario.

X-RAY-GUIDED ENDOVASCULAR SURGERY FOR SUBCLAVIAN STEAL SYNDROME (CLINICAL CASE)

Defining the sequence and methods of revascularization in patients with multifocal atherosclerosis should be associated with a minimal risk of adverse events and identification of predictors of adverse outcomes of operations, which is of great importance for improving the results of surgical treatment. We present a clinical case of successful treatment of a patient with multifocal atherosclerosis. The case included atherosclerotic disease of the left subclavian artery with complete steal syndrome of the brachiocephalic arteries, arteries of the lower limbs and arteries of the heart. It is shown that, when choosing a method for treating multifocal atherosclerosis, treatment should begin with preserving and restoring blood supply to the brain, and followed by restoring blood supply to other body parts.

Improving culprit artery identification with intraprocedural cone-beam CT aortography and its clinical impact in bronchial artery embolization.

To evaluate the impact of intraprocedural cone-beam CT (CBCT) aortography on culprit artery identification and clinical outcomes in patients undergoing bronchial artery embolization (BAE). Two hundred eighty-two patients with 317 BAE procedures were retrospectively reviewed. Patients who underwent preprocedural chest CT angiography (CTA) without intraprocedural CBCT aortography were categorized as Group A (n = 177). Patients who underwent both preprocedural chest CTA and intraprocedural CBCT aortography were categorized as Group B (n = 105). Whether CBCT can provide improved culprit artery identification and whether this improvement has a clinical impact were evaluated by comparing the two Groups. In Group B, CBCT aortography detected more culprit non-bronchial systemic arteries originating from the subclavian arteries compared to chest CTA (16 vs 3, p = 0.026), and the average number of embolized vessels was significantly higher than in Group A (2.47 ± 1.61 vs 2.03 ± 1.17, p = 0.016), while the procedure time was shorter (37.4 ± 22.0 vs 43.6 ± 22.7 min, p = 0.024). The recurrent hemoptysis rate was lower in Group B (17.5% vs 8.7%, p = 0.041), and the proportion of patients requiring subsequent procedures was significantly lower (12.4% vs 4.8%, p = 0.035). The changes in estimated glomerular filtration rate before and 3 days after the procedure (0.1 ± 12.8 vs 0.3 ± 11.0 mL/min/1.73 m2, p = 0.909) and total dose area product (DAP, 6119.5 ± 5725.7 vs 6906.2 ± 5978.6 uGym2, p = 0.279) were not significantly different between the two groups. BAE with intraprocedural CBCT aortography enabled the embolization of more culprit arteries, leading to lower recurrent hemoptysis rates without increasing the risk of renal deterioration and radiation hazards when compared to procedures without it. Question Does intraprocedural CBCT aortography improve culprit artery detection and clinical outcomes in BAE for hemoptysis? Findings CBCT aortography significantly improved the detection of additional culprit arteries, especially from non-bronchial systemic arteries, increasing the number of vessels treated during BAE. Clinical relevance Using CBCT aortography during BAE results in better long-term outcomes by reducing recurrent hemoptysis and the need for additional procedures, without increasing the risk of renal impairment.

Comparative effectiveness of Castor single-branch stent and hybrid surgery for the left subclavian artery in managing acute Type B aortic dissection with an inadequate proximal landing zone

Abstract Background Our study aims to compare the clinical outcomes and risk factors for adverse events between TEVAR with branch stent-graft and Hybrid surgery for the reconstruction of the left subclavian artery. Methods We retrospectively analyzed data from patients with insufficient proximal landing zones of acute Type B aortic dissection treated at our hospital from January 2017 to December 2022. According to the surgical method, patients were divided into TEVAR group (n=58) and Hybrid group (n=69). The primary endpoint was all-cause mortality. Results The diameter of the proximal landing zone in the TEVAR group was larger than that in the Hybrid group (31.5mm vs 30.3mm, P=0.037). Early Results: There was no significant difference in major adverse events and 30-day mortality between the TEVAR and Hybrid groups. The Hybrid group had significantly longer surgery time (110min vs 238min), hospital stay (8d vs 12d), and ICU stay (0d vs 1d) compared to the TEVAR group (P<0.001). Mid-Term Results: There was no statistical difference in mid-term mortality rates (3.4% vs 8.7%; P=0.398) between the TEVAR and Hybrid groups. The rate of mid-term adverse events was significantly higher in the Hybrid group compared to the TEVAR group (23.2% vs 6.9%; P=0.023). The rate of re-intervention was significantly higher in the Hybrid group compared to the TEVAR group (17.4% vs 3.4%; P=0.027). The 18-month freedom from mid-term adverse event rate was 93.1% (95% CI, 86.4% - 99.8%) for the TEVAR group and 76.8% (95% CI, 66.6% - 87.0%) for the Hybrid group. There was a significant difference in the rate of mid-term adverse events between the TEVAR and Hybrid groups, with the Hybrid group being higher (6.9% vs 23.2%, P=0.013). COX regression results showed: Diameter of the proximal landing zone (HR=0.6, 95%CI=0.4–0.9, P=0.009) was an independent risk factor for postoperative aortic-related adverse events. Conclusions TEVAR reconstruction of LSA and hybrid surgery are both safe and effective treatments for acute Type B aortic dissection with insufficient proximal landing zones. There is no difference in early adverse events and 30-day mortality rates between TEVAR reconstruction of LSA and hybrid surgery. Compared to hybrid surgery, TEVAR reconstruction of LSA has the advantages of shorter operation time, hospital stay, and ICU duration. There is no difference in aortic-related mortality and all-cause mortality between TEVAR reconstruction of LSA and hybrid surgery. However, TEVAR has significantly lower rates of mid-term adverse events and re-intervention compared to the hybrid group. The diameter of the proximal landing zone are risk factors for all-cause mortality.