LASER Fenestration of Thoracic Endoluminal Stent-Grafts for Preservation of the Left Subclavian Artery

Endovascular repair of a descending thoracic aortic aneurysm may result in covering the ostia of the left carotid or left subclavian artery for proper proximal landing zones, and the celiac artery or superior mesenteric artery ostia in the abdomen for distal landing zones. To prevent possible complications of occluding the ostia of these vessels, the authors performed an innominate to left common carotid and left subclavian artery bypass as the first procedure in one patient. In the second patient they performed an aortoceliac and aortomesenteric bypass before stent graft placement. The stent graft repair of the descending thoracic aortic aneurysm was performed subsequently in both patients. This aortic debranching provides subsequent proper placement of thoracic stent grafts.

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Intentional Left Subclavian Artery Occlusion by Thoracic Aortic Stent-Grafts Without Surgical Transposition

Journal of Endovascular Therapy ◽

10.1583/1545-1550(2001)008<0472:ilsaob>2.0.co;2 ◽

2001 ◽

Vol 8 (5) ◽

pp. 472-476 ◽

Cited By ~ 23

Author(s):

Klaus A. Hausegger ◽

Peter Oberwalder ◽

Kurt Tiesenhausen ◽

Josef Tauss ◽

Olaf Stanger ◽

...

Keyword(s):

Subclavian Artery ◽

Left Subclavian Artery ◽

Artery Occlusion ◽

Stent Grafts ◽

Subclavian Artery Occlusion

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Intentional Left Subclavian Artery Occlusion by Thoracic Aortic Stent-Grafts without Surgical Transposition

Journal of Endovascular Therapy ◽

10.1177/152660280100800508 ◽

2001 ◽

Vol 8 (5) ◽

pp. 472-476 ◽

Cited By ~ 62

Author(s):

Klaus A. Hausegger ◽

Peter Oberwalder ◽

Kurt Tiesenhausen ◽

Josef Tauss ◽

Olaf Stanger ◽

...

Keyword(s):

Stent Graft ◽

Subclavian Artery ◽

Left Subclavian Artery ◽

Case Reports ◽

Artery Occlusion ◽

Left Vertebral Artery ◽

Stent Grafts ◽

Subclavian Artery Occlusion ◽

Limited Experience ◽

Type B Dissection

Purpose: To report the consequences of endoluminal deployment of stent-grafts in the thoracic aorta with intentional occlusion of the left subclavian artery. Case Reports: Three patients with an aortic type-B dissection and 1 with a thoracic aneurysm were treated endoluminally with Talent stent-grafts implanted over the ostium of the left subclavian artery without prior surgical subclavian-carotid transposition. The primary intimal tears were sealed and the degenerative aneurysm excluded; blood pressure in the left arm was significantly diminished immediately after the stent-graft was released, but adequate collateral retrograde perfusion via the left vertebral artery was apparent in all patients. No neurological deficit and no symptoms of left arm ischemia were observed in a follow-up that ranged from 14 to 20 months. Conclusions: Our limited experience shows that occlusion of the left subclavian artery with a stent-graft is well tolerated. If ischemic symptoms occur, a transposition procedure can be performed on an elective basis.

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