Intentional occlusion of the left subclavian artery during stent-graft implantation in the thoracic aorta: risk and relevance.
OBJECTIVE
To examine the clinical consequences and/or potential need for postinterventional transposition after stent-graft occlusion of the left subclavian artery (LSA).


METHODS
The records of 171 consecutive patients (128 men; mean age 60.2+/-13.2 years, range 20-83) undergoing elective stent-graft repair in the thoracic aorta were reviewed to identify intentional endograft coverage of the ostial LSA, as documented by transesophageal echocardiography and/or aortography. Patients were treated for subacute type B dissection, true aneurysm, pseudoaneurysm, or previously operated type A dissection with persistent false lumen flow in the descending aorta. Among the 171 cases, 22 (12.9%) patients were identified with stent-graft occlusion of the LSA.


RESULTS
A systolic blood pressure differential existed between the right (138.4+/-14.0 mmHg) and the left (101.8+/-21.0 mmHg; p<0.05) arms after occlusion of the LSA. No patient showed a malperfusion syndrome during postinterventional hospitalization. During a mean follow-up of 24.0+/-15.8 months, 15 (68.2%) patients remained completely asymptomatic, with no functional deficit or temperature differential between the arms, while 7 patients reported mild symptoms of a subclavian steal syndrome. However, no patient required any secondary surgical intervention.


CONCLUSIONS
Stent-graft-induced occlusion of the ostial LSA was tolerated by all patients without chronic functional deficit. In the absence of stenotic vertebral and/or carotid arteries and with a documented intact vertebrobasilar system, prophylactic transposition of the LSA is not required prior to intentional stent-graft occlusion of the LSA.
Rehders
Tim C
TC
Department of Internal Medicine, Division of Cardiology, University Hospital Rostock, Germany.
Petzsch
Michael
M
Ince
Huseyin
H
Kische
Stephan
S
Korber
Thomas
T
Koschyk
Dietmar H
DH
Chatterjee
Tushar
T
Weber
Frank
F
Nienaber
Christoph A
CA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000601:surgery*; D000792:Angiography; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents / Q000009:adverse effects*; D013348:Subclavian Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016896:Treatment Outcome