Surgical left subclavian artery revascularization for thoracic aortic stent grafting: a single-centre experience in 101 patients†

Purpose: To outline the complications encountered after endoluminal treatment in patients with type B aortic dissection. Methods: Between 1999 and 2001, 14 patients (12 men; mean age 60.3 years, range 39–79) with isolated type B aortic dissection (13 chronic, 1 acute) underwent aortic stent-grafting. Three patients with chronic dissection presented an acute clinical picture and were managed emergently. The left subclavian artery was intentionally covered by the prosthesis in 9 patients. Follow-up studies were performed at 6-month intervals. Results: Stent-graft implantation was technically successful in all patients, but incomplete sealing (endoleak) of the entry site required additional proximal stent-graft implantation in 4. The left subclavian artery remained patent in 5 patients. Secondary conversion was required in 3 patients: 2 for acute type A dissection resulting from injury to the aortic arch by Talent endografts and a sustained hemorrhage (left hemothorax). In another patient, a secondary intramural hematoma subsided spontaneously. Anterior spinal artery syndrome in 1 patient persisted at 1 month. No bypass was necessary for the 9 patients with the covered left subclavian arteries. Mean follow-up was 14 months (range 1–23). Conclusions: Stent-grafting is feasible in patients with type B aortic dissection, although it is associated with a considerable rate of complications. Frank reporting of these sequelae for a variety of stent-grafts is of paramount importance to clarifying the limitations of the method.

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Fenestrated Stent Grafting for Short-necked and Juxtarenal Abdominal Aortic Aneurysm: An 8-Year Single-centre Experience

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2010.01.004 ◽

2010 ◽

Vol 39 (5) ◽

pp. 529-536 ◽

Cited By ~ 245

Author(s):

E.L.G. Verhoeven ◽

G. Vourliotakis ◽

W.T.G.J. Bos ◽

I.F.J. Tielliu ◽

C.J. Zeebregts ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Single Centre ◽

Stent Grafting ◽

Abdominal Aortic ◽

Single Centre Experience

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Less-invasive management of left subclavian artery in stent-grafting for distal aortic arch disease

Interactive Cardiovascular and Thoracic Surgery ◽

10.1510/icvts.2008.192484 ◽

2009 ◽

Vol 8 (5) ◽

pp. 548-552 ◽

Cited By ~ 7

Author(s):

Y. Kurimoto ◽

N. Kawaharada ◽

T. Ito ◽

T. Baba ◽

S. Ohori ◽

...

Keyword(s):

Aortic Arch ◽

Subclavian Artery ◽

Left Subclavian Artery ◽

Stent Grafting ◽

Less Invasive ◽

Invasive Management

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Protected and unprotected occlusion of the left subclavian artery in endovascular stent grafting of thoracic aortic pathologies

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2007-967405 ◽

2007 ◽

Vol 55 (S 1) ◽

Author(s):

S Buz ◽

B Zipfel ◽

R Hammerschmidt ◽

T Krabatsch ◽

R Hetzer

Keyword(s):

Subclavian Artery ◽

Left Subclavian Artery ◽

Endovascular Stent ◽

Stent Grafting ◽

Endovascular Stent Grafting ◽

Aortic Pathologies

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Management of Left Subclavian Artery in Endovascular Stent-Grafting for Distal Aortic Arch Disease

Circulation Journal ◽

10.1253/circj.72.449 ◽

2008 ◽

Vol 72 (3) ◽

pp. 449-453 ◽

Cited By ~ 13

Author(s):

Yoshihiko Kurimoto ◽

Toshiro Ito ◽

Ryo Harada ◽

Mamoru Hase ◽

Kenji Kuwaki ◽

...

Keyword(s):

Aortic Arch ◽

Subclavian Artery ◽

Left Subclavian Artery ◽

Endovascular Stent ◽

Stent Grafting ◽

Endovascular Stent Grafting

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When is extra-anatomical bypass for the left subclavian artery required to prevent ischaemia after thoracic endovascular stent grafting?

Asian Cardiovascular and Thoracic Annals ◽

10.1177/02184923211008074 ◽

2021 ◽

pp. 021849232110080

Author(s):

Katherine Moore ◽

Damian Miles Bailey ◽

Michael Howard Lewis ◽

Andrew Gordon ◽

Rhodri Thomas ◽

...

Keyword(s):

Thoracic Aorta ◽

Subclavian Artery ◽

Left Subclavian Artery ◽

Thoracoabdominal Aortic Aneurysm ◽

Aortic Disease ◽

Thoracic Aortic Disease ◽

Stent Grafting ◽

Landing Zone ◽

Presenting Symptoms ◽

Group I

Introduction Thoracic endovascular aortic repair (TEVAR) has become an accepted treatment for thoracic aortic disease. However, the principal complications relate to coverage of the thoracic aortic wall and deliberate occlusion of aortic branches over a potentially long segment. Complications include risk of stroke, spinal cord ischaemia (SCI) and arterial insufficiency to the left arm (left arm ischaemia (LAI)). This study specifically scrutinised the development of SCI and LAI after TEVAR for interventions for thoracic aortic disease from 1999 to 2020. In particular, those who underwent extra-anatomical bypass (both immediate and late) were compared to the length of thoracic aortic coverage by the stent graft. Materials and methods Ninety-eight patients underwent TEVAR. The presenting symptoms, pathology, procedural and follow-up data were collected prospectively with particular evidence of stroke, SCI and LAI both immediate onset and after 48 h of graft placement. Results Fifty underwent TEVAR for an aneurysm (thoracoabdominal aortic aneurysm), 22 for dissection, 19 for acute transection and 7 for intramural haematoma/pseudoaneurysm of the thoracic aorta. Twenty-nine (30%) required a debranching procedure to increase the proximal landing zone (1 aorto-carotid subclavian bypass, 10 carotid/carotid subclavian bypass and 18 carotid/subclavian bypass). Ten patients (10%) died within 30 days of TEVAR. Twenty-four grafts covered the left subclavian artery origin without a carotid/subclavian bypass. Five required a delayed carotid/subclavian bypass for LAI (4) and SCI (1). Six developed immediate signs of SCI after TEVAR and these 11 (group i) had a mean (SD) length of coverage of the thoracic aorta of 30.2 (10.6) cm compared to 21.5 (11.2) cm (group g) in those who had no LAI or SCI post TEVAR, p < 0.05. Conclusions In this series, delayed carotid/subclavian bypass may be required for chronic arm ischaemia and less so for SCI. The length of coverage of thoracic aorta during TEVAR is a factor in the development of delayed SCI and LAI occurrence. Carotid subclavian bypass is required for certain patients undergoing TEVAR (particularly if greater than 20 cm of thoracic aorta is covered).

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