Left subclavian artery management in endovascular repair of thoracic aortic aneurysms and aortic dissections.
OBJECTIVE
The purpose is to report our experience and revise our previously published results in endovascular repair of short-necked thoracic aortic aneurysms or aortic type B dissections, in which the left subclavian artery (LSA) was occluded by the stent graft intentionally.


METHODS
Seven patients with an aortic type B dissection and three patients who had a thoracic aortic aneurysm were treated endovascularly with stent grafts. In all patients the ostium of the LSA was occluded by the stent graft, only in two patients a primary, prophylactic revascularization of the LSA was performed by transposition to the left common carotid artery (LCA). Two types of stent grafts were used: the Talent (Medtronic) and the Excluder (Gore) stent graft.


RESULTS
In all patients the sealing of the entry tear in aortic dissections and the exclusion of existing thoracic aortic aneurysms were achieved. No immediate neurological deficit or left arm ischemia occurred. Nevertheless, during a mean follow-up of 18 months (2 to 31 months) in three patients a second surgical intervention had to be performed due to subclavian steal syndrome, left arm ischemia, or continuing perfusion of the dissected false aortic channel.


CONCLUSIONS
Intentional occlusion of the LSA in stent-graft repair of thoracic aortic diseases seems to be a safe procedure. Close follow-up is needed due to arising subclavian steal syndrome, arm ischemia, or persistent perfusion of the false channel via LSA in aortic dissections after patients' discharge, requiring surgical intervention.
Tiesenhausen
Kurt
K
Department of Vascular Surgery, University Hospital Graz, Auenbruggerplatz 29, 8036 Graz, Austria. kurt.tiesenhausen@kfunigraz.ac.at
Hausegger
Klaus A
KA
Oberwalder
Peter
P
Mahla
Elisabeth
E
Tomka
Maurice
M
Allmayer
Thomas
T
Baumann
Anneliese
A
Hessinger
Michael
M
D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D003097:Collateral Circulation / Q000502:physiology; D006801:Humans; D015607:Stents; D013348:Subclavian Artery / Q000601:surgery*