Deliberate Subclavian Artery Occlusion during Aortic Endovascular Repair: Is it Really that Safe?

Ferreira, Marcelo Paglioli; Monteiro, Marcelo; Lanziotti, Luiz; Abuhadba, Giafar; Capotorto, Luis Fernando

doi:10.1016/j.ejvs.2006.12.013

Cited by 13 publications

(6 citation statements)

References 15 publications

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“…The random effects meta-analyses comparing postoperative outcomes after TEVAR showed a trend in favor of revascularization (Fig 2). The LSA revascularization was not associated with a statistically significant reduction in adverse events apart from arm-related events (OR 0.36, 95% CI: 0.15 to 0.85, p ¼ 0.02), where heterogeneity and statistical bias were nonsignificant (n ¼ 1,061 patients; I 2 ¼ 18%, Cochran Q p ¼ 0.24, and Egger test p ¼ 0.721; Fig 3) [3,7,[19][20][21][22][23][24][25][26][27][28][29][30][31].…”

Section: Resultsmentioning

confidence: 95%

The Effect of Left Subclavian Artery Coverage in Thoracic Endovascular Aortic Repair

Sobocinski

Patterson

Karthikesalingam

et al. 2016

The Annals of Thoracic Surgery

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We propose a systematic review that compares outcomes after intentional coverage of the left subclavian artery during thoracic endovascular repair with and without prior surgical revascularization. According to Preferred Items for Reporting of Systemic Reviews and Meta-Analyses guidelines, PubMed and Embase searches identified studies reporting patients with left subclavian artery coverage during thoracic endovascular repair and their subsequent outcomes. Analyzing a varied patient cohort, there are nonstatistically significant trends that favor left subclavian artery revascularization in preventing stroke (odds ratio 0.76, 95% confidence interval: 0.49 to 1.18) and spinal cord ischemia (odds ratio 0.73, 95% confidence interval: 0.38 to 1.38); that was significant in reducing arm-related ischemia (p = 0.02). Further investigations should try to define subgroups of patients who might benefit from revascularization or who would derive no benefit.

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Section: Resultsmentioning

confidence: 95%

The Effect of Left Subclavian Artery Coverage in Thoracic Endovascular Aortic Repair

Sobocinski

Patterson

Karthikesalingam

et al. 2016

The Annals of Thoracic Surgery

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“…Ferreria et al 25 reviewed a series of 81 TEVARs in which 21 LSA ostia were covered. Two of these patients underwent primary subclavian-carotid transposition due to concerns about cerebral perfusion in one and arm perfusion in the other.…”

Section: Selective Lsa Revascularizationmentioning

confidence: 99%

Management of the Left Subclavian Artery During Endovascular Repair of the Thoracic Aorta

Noor¹,

Sadat²,

Hayes³

et al. 2008

Journal of Endovascular Therapy

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Endovascular repair is rapidly becoming the treatment of choice for thoracic aortic disease, which oftentimes involves or lies in close proximity to the left subclavian artery (LSA). In order to extend the proximal landing zone for the stent-graft and obtain an adequate seal, the LSA ostium is often covered, with or without concomitant subclavian artery revascularization. In this article, we review the LSA anatomy and consequences of LSA coverage as a backdrop for a discussion of the ramifications of LSA coverage during endovascular thoracic aortic repair (TEVAR). Early series reported high rates of LSA revascularization as an adjunct to endovascular repair for aortic pathology adjacent to the LSA ostium. Initial reports of low morbidity associated with simple LSA ostium coverage are not supported by contemporary literature, which suggests revascularization reduces the risks of cerebrovascular accident and spinal cord ischemia. Coverage of the LSA without revascularization may be justified only in emergency situations or when thorough investigations of cerebral and vertebrobasilar circulation have concluded that the risk to brain and spinal cord is low. Subclavian revascularization should be considered in the presence of a dominant left vertebral artery, bilateral carotid artery disease, an occluded/stenosed right vertebral artery, presence of a left internal mammary artery graft, or when a long length of thoracic aorta is covered.

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“…34,36,37 At discharge, 13% to 35% of patients had a symptomatic left arm due to occlusion of the LSA. 30,33,34,36—38 Nevertheless, symptoms regressed completely in the majority of patients; the rate of late LSA revascularization was 2% to 14%. 30,33,34,36—38 With the exception of 2 studies, 35,36 the majority of authors did not report cerebral ischemic complications resulting from coverage of the LSA.…”

Section: Discussionmentioning

confidence: 94%

“…Therefore, some authors have proposed intentionally covering the LSA with the endograft, reserving its revascularization for selected cases. 8,30—38 Analysis of outcomes of this type of procedure demonstrated significant differences in pressure between the arms in more than 50% of cases, with a reversed flow in the vertebral artery assessed by duplex scan in 32% to 71% of cases. 34,36,37 At discharge, 13% to 35% of patients had a symptomatic left arm due to occlusion of the LSA.…”

Section: Discussionmentioning

confidence: 99%

Ten Years of Endovascular Aortic Arch Repair

Chiesa

Melissano

Tshomba

et al. 2010

Journal of Endovascular Therapy

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Deliberate Subclavian Artery Occlusion during Aortic Endovascular Repair: Is it Really that Safe?

Abstract: In this series deliberate occlusion of the SA led to SSS in a significant number of patients. Consideration should be given to primary subclavian transposition in some patients requiring subclavian occlusion.

Cited by 13 publications

References 15 publications

The Effect of Left Subclavian Artery Coverage in Thoracic Endovascular Aortic Repair

The Effect of Left Subclavian Artery Coverage in Thoracic Endovascular Aortic Repair

Management of the Left Subclavian Artery During Endovascular Repair of the Thoracic Aorta

Ten Years of Endovascular Aortic Arch Repair

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