| Background Thoracic endovascular aortic repair(TEVAR) has rapidly become an accepted treatment option for numerous aortic pathologies including thoracic aortic dissection, thoracic aortic aneurysm, thoracic aortic ulcers and intramural hematoma. TEVAR has become the primary method for the treatment of descending aorta diseases because of the less invasion, lower complications, shorter operative time and hospital stays compared with the conventional surgery. However, the insufficiency of the proximal landing zone has proved to be the main limit for the widely usage in clinical. The left subclavian artery is usually completely or partially covered in order to obtain sufficient landing zoon. But, its security is controversial.Objective The objective of this study was to compare the mortality and incidence of related complications during the perioperative and follow-up period after covering different degree of left subclavian artery in TEVAR and analyze the impact on the cerebrovascular, spinal cord and left arm ischemia.Method The study consisted of 250 patients with the operation of TEVAR from our cardiovascular surgery and vascular surgery, including 243 cases of type B aortic dissection and 7 cases of thoracic aortic aneurysms. The TEVAR group included 207 men and 43 women with an average age of 51.9±10.5 years. According to the degree of LSA coverage, the Patients were divided into four groups. Group A consisted of 112 patients with the LSA completely covered; Group B consisted of 34 patients and the degree of the LSA coverage was more than or equal to half; Group C was composed of 29 patients and the degree was less than 50 percent; Group D was composed of 75 patients without the coverage of the LSA; Group E was composed of 8 patients with revascularization of the LSA. The mortality of the left upper limb ischemia, cerebral ischemia, spinal cord ischemia and the presence of endoleak were compared during the perioperative and follow-up period. The DASH(the disabilities of the Arm, Shoulder and Hand) and NIHSS(the National Institutes of Health Stroke Scale) were used to evaluate the left upper limb ischemia and cerebral ischemia respectively.Result While in hospital, 2 patients in Group D were died and the mortality was 0.8%. The endoleak occurred in 2 cases in Group A and 1 case in Group D and were disappeared after management. One patient in Group D had an incomplete paraplegia postoperatively and recovered after treatment. Stroke and severe left arm ischemic were not found in 5 groups at the time of hospitalization. The follow-up duration ranged from 6-66 months, and the follow-up rate was 73.8%. During the follow-up period the mortality in the five groups were 3.8%, 4.2%, 4.8%, 3.7% and 0 respectively(p > 0.05);the incidence of endoleak were 16.7%, 8.3%, 9.5%, 20.4%,16.7%(p > 0.05) and there were no statistical difference. The scores of the DASH and NIHSS were similar and no one experienced paraplegia or paraparesis in five groups.Conclusions TEVAR is a safe and effective treatment for thoracic aortic disease and the morbidity of the CVI, SCI and LAI was very low. With the strategy of selective LSA revascularization according to the status of the bilateral vertebral artery, carotid artery and related clinical history, the coverage of LSA doesn't increase the LSA related complications and the incidence of endoleak. |
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