Outcomes of carotid-subclavian bypass performed in the setting of thoracic endovascular aortic repair

Anatomic Variation of the Phrenic Nerve and Brachial Plexus Encountered during 100 Supraclavicular Decompressions for Neurogenic Thoracic Outlet Syndrome with Associated Postoperative Neurologic Complications

“…Phrenic nerve palsy was demonstrated in 25% (27 of 107) of carotidsubclavian bypass performed in conjunction with TEVAR. 8 Half of all patients (52%, n ¼ 14) had complete recovery, while the remaining 13 patients sustained permanent severe diaphragmatic dysfunction or paralysis. No brachial plexus injuries were reported.…”

Stent placement for long-segment total occlusion of an aberrant right subclavian artery: A 7-year follow-up

“…A recent surgical series cited phrenic nerve palsy in 25%, recurrent laryngeal nerve palsy in 5%, axillary nerve palsy in 2%, and neck hematoma requiring re-exploration in 1%. 12 …”

“…In addition, it predisposes to aortic rupture and dissection. 12 There is widespread agreement that symptomatic KD merits repair, whereas the management in the absence of symptoms is less clear. A standard surgical approach has been subclavian-common carotid artery transposition or bypass in conjunction with KD resection and interposition aortic grafting.…”

Commentary: Left subclavian artery revascularization during zone 2 thoracic endovascular aortic repair: Bypass versus transposition? Just do it!

“…Our group has previously published on the safety of a selective LSA revascularization strategy, 10 although in practice we revascularize the LSA essentially 100% of the time when it is fully covered with little to no preservation of antegrade flow. 11 It should be noted that, in many cases, the LSA can be only partially covered so as to gain additional proximal seal, yet without significant interruption of antegrade flow. 7 Our practice is to place bilateral radial arterial lines in all cases where either full or partial LSA coverage is planned, 10 and for those cases with partial coverage, to confirm preservation of left radial arterial line pulsatility after endograft deployment.…”

“…These seem like reasonable assertions, although our group found no wound or graft infections in a larger series (n ¼ 112) of carotidsubclavian bypass procedures performed using polytetrafluoroethylene grafts in the setting of zone 2 TEVAR. 11 Likewise, type II endoleak is easily avoided in the scenario of bypass using endovascular means such as occlusion plugs or coils, which we have done routinely for the past 15 years. Further, ligation of the LSA at the aortic arch as required to prevent type II endoleak with transposition becomes increasingly challenging in the setting of morbid obesity or vessel fragility, which is a common finding due to the thin-walled nature of the supraclavicular LSA.…”