Outcomes of Thoracic Endovascular Aortic Repair and Subclavian Revascularization Techniques

Zamor, Kimberly C.; Eskandari, Mark K.; Rodríguez, Herón E.

doi:10.1016/j.jvs.2016.02.007

Cited by 10 publications

(22 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It may only be performed after TEVAR, if there is an indication such as critical ischemia or stress-induced ischemia of the upper extremity, or neurological defi cits due to absent or insuffi cient collateral perfusion and refi lling of the LSA from the vertebrobasilar region [3,9]. On the other hand, several groups favor primary revascularization of the LSA with a carotid-carotid bypass or LSA transposition to prevent complications after TEVAR [4].…”

Section: Discussionmentioning

confidence: 99%

“…Stanford type A aortic dissection and contained aortic rupture occurred in two patients (12.5 %). The indication for reintervention [4,7,8]. There are also studies showing that patients who did not undergo prophylactic revascularization had a signifi cantly increased rate (25 %) of stroke in the fi rst 30 postoperative days, much higher than the rate in revascularized patients (2 %) [4].…”

Section: Discussionmentioning

confidence: 99%

“…There are also studies showing that patients who did not undergo prophylactic revascularization had a signifi cantly increased rate (25 %) of stroke in the fi rst 30 postoperative days, much higher than the rate in revascularized patients (2 %) [4]. The incidence of upper extremity ischemia reported in the literature is signifi cantly higher in patients without prior revascularization (15 %) than in patients with primary carotid-subclavian bypass or subclavian artery transposition (0 %) [4]. Other groups also reported an increased occurrence of stroke after LSA in patients without a prophylactic revascularization (5.6 vs. 3.1 %) [7].…”

Section: Discussionmentioning

confidence: 99%

“…Coverage of up to 40 % of the left subclavian artery (LSA) during aortic stent implantation is unavoidable [2,3]. Possible consequences of the overstenting of the LSA are numerous and may include the occurrence of neurological complications such as cerebral insults, spinal ischemia, or ischemia of the left upper extremity [4,5]. The optimal treatment strategy and complication rates are controversial and have been thoroughly discussed in the literature [6].…”

Section: Introductionmentioning

confidence: 99%

“…The current recommendation for routine prophylactic revascularization of the LSA before TEVAR remains controversial [6]. Some authors explicitly recommend primary revascularization of the LSA to minimize the risk of neurological and ischemic complications [4,7,8]. Other research groups do not see the benefi t of primary revascularization because of the unrestricted and unchanged daily ultrasound and CT angiography, the vertebral arteries had comparable, normal diameters (no hypoplasia).…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Management of the left subclavian artery during TEVAR – complications and mid-term follow-up

Youssef

Ghazy

Kersting

et al. 2018

Vasa

View full text Add to dashboard Cite

Summary:Background: Numerous conditions that affect the boundary between the aortic arch and descending aorta are treated with thoracic endovascular aortic repair (TEVAR). In 40 % of cases, coverage of the left subclavian artery (LSA) cannot be prevented. Subsequently, neurological complications such as stroke or ischemia of the left upper extremity may develop. However, the actual risk of these complications is subject to considerable controversy. The optimal treatment approach, specifi cally the question whether primary revascularization of the LSA should be performed in all cases, is unclear. Patients and methods: The present retrospective study analyzed the short-and mid-term results of patients treated with TEVAR with complete coverage of the LSA. The postoperative protocol consisted of clinical and noninvasive examinations as well as morphological imaging. Survival, complication, and reintervention rates were recorded. Results: A total of 40 patients, undergoing TE-VAR with complete coverage of the LSA between January 2010 and December 2014 were analyzed retrospectively. The 30-day survival rate was 95 %, the survival one year after performed TEVAR was 67.5 %. The average follow-up was 1.5 years. After TEVAR procedure with complete coverage of the LSA, only one patient (2.5 %) developed critical ischemia of the left arm immediately after aortic stent implantation, requiring revascularization by transposition of the LSA. Anterior spinal artery syndrome occurred in another patient (2.5 %) immediately following TEVAR. During follow-up examinations, all patients showed a compensated arterial arm status. None of the patients developed new neurological defi cits during the follow-up period. Conclusions: The study shows that performing TEVAR without primary revascularization of the LSA was justifi able in our cohort. An important risk factor of developing cerebral ischemia seems to be insuffi cient collateralization through the circle of Willis.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Management of the left subclavian artery during TEVAR – complications and mid-term follow-up

Youssef

Ghazy

Kersting

et al. 2018

Vasa

View full text Add to dashboard Cite

show abstract

The fate of the left subclavian artery in TEVAR for aortic arch pathology

Bashir

Bailey

Jones

et al. 2021

Journal of Cardiac Surgery

View full text Add to dashboard Cite

Background and aim of study: The origin of the vertebral artery (VA) from the left subclavian (LSA) is variable and must be considered when proximal ligation or embolization is performed post thoracic endovascular aortic repair (TEVAR) and extraanatomical bypass (EAB). A retrospective study was conducted to understand the patency of the LSA and VAs after TEVAR and the relationship of the EAB to the LSA. Methods: Fifty-six patients underwent TEVAR where the LSA origin was occluded. A comparison was performed between the length of the proximal LSA from the arch of the aorta to the origin of the VA. Patient outcomes included posterior or anterior circulation cerebrovascular accident, spinal cord ischemia (SCI), and symptoms and signs of left arm ischemia (LAI). Thirty one underwent EAB with 8 undergoing occlusion of the LSA proximal to the origin of the left VA. A further 25 underwent How to cite this article: Bashir M, Bailey D, Jones WD, White RD, Williams IM. The fate of the left subclavian artery in TEVAR for aortic arch pathology.

show abstract

Meta-analysis of Left Subclavian Artery Coverage With and Without Revascularization in Thoracic Endovascular Aortic Repair

et al. 2016

View full text Add to dashboard Cite

show abstract

Outcomes of Thoracic Endovascular Aortic Repair and Subclavian Revascularization Techniques

Cited by 10 publications

References 10 publications

Management of the left subclavian artery during TEVAR – complications and mid-term follow-up

Management of the left subclavian artery during TEVAR – complications and mid-term follow-up

The fate of the left subclavian artery in TEVAR for aortic arch pathology

Meta-analysis of Left Subclavian Artery Coverage With and Without Revascularization in Thoracic Endovascular Aortic Repair

Contact Info

Product

Resources

About