scholarly journals One-year outcome of postoperative stroke and nerve injury after supraclavicular revascularization of the left subclavian artery for proximal landing zone extension in thoracic endovascular aortic repair

2021 ◽  
Author(s):  
J. Brusa ◽  
E. Lutz ◽  
F. Schönhoff ◽  
S. Weiss ◽  
J. Schmidli ◽  
...  
Keyword(s):  
Nerve Injury ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Landing Zone ◽  
Postoperative Stroke ◽  
Aortic Repair ◽  
One Year

scholarly journals Early outcomes after left subclavian artery revascularisation in association with thoracic endovascular aortic repair

Vascular ◽  
2016 ◽  
Vol 25 (1) ◽  
pp. 74-79 ◽  
Author(s):  
Dare Oladokun ◽  
Benjamin O Patterson ◽  
Jack RW Brownrigg ◽  
Jorg L deBruin ◽  
Peter J Holt ◽  
...  
Keyword(s):  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Tertiary Hospital ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Complication Rates ◽  
Landing Zone ◽  
Aortic Repair

Approximately 40–50% of patients undergoing thoracic endovascular aortic repair require left subclavian artery coverage for adequate proximal landing zone. Many of these patients undergo left subclavian artery revascularisation. However, outcomes data for left subclavian artery revascularisation in the context of thoracic endovascular aortic repair remain limited. In this study, 70 left subclavian artery revascularisation procedures, performed on thoracic endovascular aortic repair patients at a tertiary hospital, were retrospectively reviewed. Particular emphasis was placed on revascularisation-related outcomes during staging interval between revascularisation and thoracic endovascular aortic repair. Forty-six (66%) carotid-subclavian bypass, 17 (24%) carotid-carotid-subclavian bypass and 7 (10%) aorto-inominate-carotid-subclavian bypass procedures were performed. There were no strokes or mortalities following left subclavian artery revascularisation procedures alone. Three (10%) minor complications occurred including a seroma, a haematoma and a temporary neuropraxia. Separation of complications following left subclavian artery revascularisation from those of the associated thoracic endovascular aortic repair can be difficult. Early outcomes data from patients who underwent left subclavian artery revascularisation in isolation indicate that the procedure is safe with low complication rates.

scholarly journals Outcome after cervical debranching for proximal landing zone extension in thoracic endovascular aortic repair

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
V Makaloski ◽  
E Lutz ◽  
R Bühlmann ◽  
S Weiss ◽  
J Schmidli
Keyword(s):  
Nerve Injury ◽  
Cranial Nerve ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Safe Procedure ◽  
Long Term Outcome ◽  
Landing Zone ◽  
Postoperative Stroke ◽  
Aortic Repair

Abstract Objective Aim of this study was to assess perioperative and long-term outcome after cervical debranching for proximal landing zone extension in thoracic endovascular aortic repair (TEVAR). Methods Retrospective analysis of all patients undergoing left-sided carotid-subclavian bypass (CSB) and subclavian-carotid transposition (SCT) with simultaneous or staged TEVAR between 2010 and 2019. Endpoints were patency and re-intervention due to the debranching, postoperative stroke, cranial nerve injury and mortality at 30 days and during follow-up. Results Forty-eight patients (66 ± 12 years, 81 % male) had 25 (52%) CSB and 23 (48%) SCT. TEVAR was performed simultaneously in 39 (81%). Eleven (23%) patients had simultaneous emergency debranching and TEVAR. There were eight (17%) re-interventions within 30 days: four due to local hematoma, one for bypass occlusion, two for stenosis (of which one was not confirmed intraoperatively), and one after initially abandoned SCT with subsequent CSB on the next day. Thirty-day mortality was 2 %; one patient died on the first postoperative day after combined CABG surgery and multiorgan failure. Four (8%) patients suffered postoperative strokes; three occurred after simultaneous emergency procedures and none was fatal. Seven (15%) patients had postoperative ipsilateral cranial nerve lesions: two occurred after CSB and five after SCT. Two patients had recurrent laryngeal nerve palsy, two had phrenic nerve injury and three had Horner syndrome. All patients had mild symptoms and recovered mostly. During a mean follow-up of 31±29 months with a Follow-up Index of 0.77, there were no reinterventions or occlusions, and no graft infections. Primary patency was 94%, primary assisted patency 96%, and secondary patency 100%. 9 patients died during follow-up after a mean of 30±29 months (range 0-82) all of them with patent cervical debranching. Conclusion Cervical debranching for proximal landing zone extension in TEVAR is a safe procedure with an acceptable rate of early re-interventions. There is a higher risk for postoperative stroke during simultaneous emergency debranching and TEVAR. Cranial nerve injuries and hematomas remain relevant periprocedural complications. During follow-up, excellent patency can be expected.

Midterm outcomes of fenestrated TEVAR using physician-modified endovascular grafts for zone 2

Vascular ◽  
2021 ◽  
pp. 170853812110196
Author(s):  
Jiaxue Bi ◽  
Fang Niu ◽  
Peng Li ◽  
Xiangchen Dai ◽  
Jiechang Zhu ◽  
...  
Keyword(s):  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Perioperative Complications ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Landing Zone ◽  
Aortic Repair ◽  
Primary Endpoints ◽  
Endovascular Grafts

Objectives To summarize the experience and midterm outcomes of physician-modified endovascular grafts for zone 2 thoracic endovascular aortic repair. Methods A retrospective analysis was conducted of 51 consecutive patients (mean age 57.6 ± 12.5 years, 39 males) treated with thoracic endovascular aortic repair using physician-modified endovascular grafts for reconstructing the left subclavian artery from November 2015 to December 2019. The primary endpoints during follow-up were the overall mortality, aorta-related mortality, and major complications. The secondary endpoints were reintervention and the patency of the target branches, the demographics and technical details were also described and analyzed. Results Sixty-three thoracic stent-grafts were deployed in 51 patients and emergency surgery was performed in 10 patients (19.6%). Technical success was 94.1% (48/51). The incidence of perioperative complications was 15.7%, and the 30-day mortality was 0%. At a mean follow-up of 42.0 ± 14.4 months (range, 14–63 months), all the left subclavian arteries remained patent. All-cause mortality was 3.9% (2/51) and not aorta-related deaths. Estimated survival at one and three years was 98.0 ± 1.9% and 96.0 ± 2.8%, respectively. Conclusions The physician-modified endovascular grafts is feasible and effective to preserve left subclavian artery in thoracic endovascular aortic repair for aortic arch pathologies with unhealthy proximal landing zone.

scholarly journals Results With a Selective Revascularization Strategy for Left Subclavian Artery Coverage During Thoracic Endovascular Aortic Repair

2011 ◽  
Vol 92 (1) ◽  
pp. 97-103 ◽  
Author(s):  
Teng C. Lee ◽  
Nicholas D. Andersen ◽  
Judson B. Williams ◽  
Syamal D. Bhattacharya ◽  
Richard L. McCann ◽  
...  
Keyword(s):  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair

scholarly journals Management of the Left Subclavian Artery During Thoracic Endovascular Aortic Repair

2016 ◽  
Vol 64 (5) ◽  
pp. 1535
Author(s):  
Kyle A. Arsenault ◽  
Jason Faulds ◽  
Darren Klass ◽  
Joel Price ◽  
Michael T. Janusz
Keyword(s):  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair

scholarly journals Thoracic Endovascular Aortic Repair With Left Subclavian Artery Coverage Is Associated With a High 30-Day Stroke Incidence With or Without Concomitant Revascularization

2020 ◽  
Vol 27 (5) ◽  
pp. 769-776
Author(s):  
Rens R. B. Varkevisser ◽  
Nicholas J. Swerdlow ◽  
Livia E. V. M. de Guerre ◽  
Kirsten Dansey ◽  
Chun Li ◽  
...  
Keyword(s):  
Subclavian Artery ◽  
Real World ◽  
Left Subclavian Artery ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Stroke Incidence ◽  
Perioperative Stroke ◽  
Factors Associated ◽  
Real World Setting ◽  
Aortic Repair

Purpose: To evaluate the perioperative stroke incidence following thoracic endovascular aortic repair (TEVAR) with differing left subclavian artery (LSA) coverage and revascularization approaches in a real-world setting of a nationwide clinical registry. Materials and Methods: The National Surgical Quality Improvement Program registry was interrogated from 2005 to 2017 to identify all nonemergent TEVAR and/or open LSA revascularization procedures. In this time frame, 2346 TEVAR cases met the selection criteria for analysis. The 30-day stroke incidence was compared between patients undergoing TEVAR with (n=888) vs without (n=1458) LSA coverage, for those with (n=228) vs without (n=660) concomitant LSA revascularization among those with coverage, and following isolated LSA revascularization for occlusive disease (n=768). Multivariable logistic regression was employed for risk-adjusted analyses and to identify factors associated with stroke following TEVAR. Results of the regression analyses are presented as the adjusted odds ratio (OR) with 95% confidence interval (CI). Results: The stroke incidence was 2.3% following TEVAR without vs 5.2% with LSA coverage (p<0.001). In TEVARs with LSA coverage, the stroke incidence was 7.5% when the LSA was concomitantly revascularized and 4.4% without concomitant revascularization, while stroke occurred in 0.5% of isolated LSA revascularizations. Of 33 TEVAR patients experiencing a perioperative stroke, 8 (24%) died within 30 days. LSA coverage was associated with stroke both with concomitant revascularization (OR 4.0, 95% CI 2.2 to 7.5, p<0.001) and without concomitant revascularization (OR 2.2, 95% CI 1.3 to 3.8, p=0.002). Other preoperative factors associated with stroke were dyspnea (OR 1.8, 95% CI 1.1 to 3.0, p=0.014), renal dysfunction (OR 2.2, 95% CI 1.0 to 3.8, p=0.049), and international normalized ratio ≥2.0 (OR 3.6, 95% CI 1.0 to 13, p=0.045). Conclusion: Stroke following TEVAR with LSA coverage occurs frequently in the real-world setting, and concurrent LSA revascularization was not associated with a lower stroke incidence.

Sign in / Sign up

Export Citation Format

Share Document