Research Of Coverage Of Left Subclavian Artery In Thoracic Endovascular Aortic Repair

Purpose:TEVAR, a minimally invasive technique is replacing conventional open surgery for desending aortic pathologies with advantage of small risk and early recovery. However, TEVAR seems not to decrease the risk of postoperaive paraplegia and stroke. Whether LSA coverage increase these risk in TEVAR is still controversial, and its potential long-term complication is unknown.Methods:629TEVAR from Jan2004to Mar2014were reviewed retrospectively, including540AD,38desending TAA,44aortic ulcer and IMH and7aortic pseudoaneurysm. LSA was intentional covered in230patients during TEVAR,8patient with LSA coverage undergone LSA revascularization including LCCA-LSA bypass, LSA chimney graft and single-branch graft. In-hospital mortality, stroke and postoperative paraplegia in LSA uncovered and partial/complete covered patients was tested with χ2test. All cause death, late stroke and paraplegia recovery were investigated during long-term follow up, survival difference between LSA coverage and patent LSA groups is tested with Kaplan-Meier analysis. The corresponding odds ratios of stroke risk in patients with LSA coverage is calculated with logistic regression analysis.Results:Technical success was100%. In-hospital mortality was0.64%. No acute limb-threatening ischemia developed. Stroke rate was0.47%. Postoperative paraplegia rate was0.5%. In-hospital mortality, stroke rate and postoperative paraplegia rate between LSA coverage and non-coverage were not significantly different. Mean follow-up time was31.4months (1-123months). LSA coverage do not increase the long-term stroke risk, and stoke history before operation and older than70years of age are risk factors for stroke during follow-up (OR=3.41, P=0.023and OR=1.90, P=0.034). Most patients have a satisfied recovery of muscle strength of lower extremities during follow-up.Conclusions:LSA coverage in TEVAR with selective LSA revascularization do not increase risk of in-hospital mortality, stoke and postoperative paraplegia and long-term stroke risk. LSA coverage can be well tolerated.