Clinical Experience Of Left Subclavian Artery Revascularization In In The Setting Of Thoracic Endovascular Aortic Repair

Objective:Left subclavian artery revascularization(LSCA)is frequently performed in the setting of thoracic endovascular repair(TEVAR).The purpose of this study was to compare different techniques for LSCA revascularization during TEVAR.Methods:We performed a single-center’s retrospective cohort study from 2016 to 2019.Patients were categorized by LSCA revascularization methods,including direct coverage without revascularization(Unrevascularized),carotid-subclavian bypass(CSB)and fenestrated thoracic endovascular aortic repair(F-TEVAR).Indications,demographics,operation details,and outcomes were analyzed using standard statistical analysis.Results:171 patients underwent TEVAR with LSA coverage,16.4%(n=28)were unrevascularized and the remaining patients underwent CSB(n=100 [58.5%])or F-TEVAR(n=43 [25.1%]).Demographics were similar between the unrevascularized and revascularized groups,except for procedure urgent status(p = 0.005).The incidence of postoperative spinal cord ischemia was significant higher between unrevascularized and revascularized group(10.7% vs 1.4%;p = 0.032).There was no difference in 30-day and mid-term rates of mortality,stroke,and left upper extremity ischemia.CSB was more likely time-consuming than F-TEVAR [3.25(2.83-4)vs 2(1.67 – 2.67)hours,p = 0],but there were no statistically significant differences in30-day or midterm outcomes for CSB vs F-TEVAR.During a mean follow-up time of24.8 months,estimates survival rates had no difference.Conclusion:LSA revascularization in zone 2 TEVAR is necessary which is associated a low30-day rate of spinal cord ischemia.When LSA revascularization is required during TEVAR,CSB and F-TEVAR are all safe and effective methods,and F-TEVAR appears to offer equivalent clinical outcomes as a less time-consuming and minimally invasive alternative.