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

Abstract

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.

Mid‐term efficacy of castor stent and in situ fenestration stent in the treatment of type B aortic dissection involving the left subclavian artery: A retrospective single‐center study

“…Consequently, the LSA opening is occluded, or the chimney technique is performed. 25 During the follow-up period, we found that stent stenosis and entry flow from disconnected stents was more common in the ISFs group than in the CSs group. In the CSs approach, the branch and main stent grafts were integrated and well anastomosed.…”

“…Conversely, when in situ fenestration fails or the angle is unsatisfactory, we cannot retract the stent. Consequently, the LSA opening is occluded, or the chimney technique is performed 25 …”

Gore cTAG sleeve-associated maldeployment for traumatic aortic injury with aberrant right subclavian artery

“…Fewer than 10% of patients require an extremity intervention. 2 , 3 However, an aberrant right subclavian artery (RSA) is a rare anatomic variant (0.16%-2%) that complicates aortic repair. 4 , 5 In this variant, the RSA exits the descending aorta, usually in zone IV, and routinely requires endograft coverage, decreasing the perfusing pressures to the aforementioned collateral beds.…”