title: Reevaluating the need for left subclavian artery revascularization with thoracic endovascular aortic repair.
abstract: BACKGROUND
  With increased utilization of thoracic endovascular aortic repair (TEVAR), the anatomic limitations of proximal device landing zones are being challenged. As our experience has grown with TEVAR involving exclusion of the left subclavian artery (LSA), the need for selective revascularization of the LSA appeared to be more common than we initially anticipated. We hypothesize that for patients undergoing TEVAR requiring coverage of the LSA, the need for LSA revascularization is higher than reported in the literature.
  
  
  METHODS
  The charts of all patients undergoing TEVAR performed at a single tertiary care center from 1999 to 2006 were reviewed. The review included the preoperative radiographic evaluations, the assessment of comorbidities, the anatomic position of the proximal and distal landing zones, outcomes, complications, and the need for preoperative or postoperative subclavian artery revascularization.
  
  
  RESULTS
  Sixty-four patients underwent TEVAR and 27 (42%) of these patients required exclusion of the LSA from the thoracic aorta. Seven of these 27 patients (25.9%) required preoperative LSA revascularization. Four patients developed late symptoms, necessitating LSA revascularization. No patients died or developed paraplegia, but three adverse neurological events occurred unrelated to the posterior fossa circulation. No patient developed any left arm disability.
  
  
  CONCLUSIONS
  The TEVAR coverage of the LSA with selective revascularization was safe for patients, but greater than 11 of 27 (40.7%) required either preoperative or postoperative LSA revascularization. Although this study represents our early experience with TEVAR, these data suggest that selective revascularization after TEVAR exclusion of the origin of the LSA may be required more frequently than previously reported.
authors: Department of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA. brett.reece@uchsc.edu
authors: T Brett
authors: TB
authors: Reece
authors: Leo M
authors: LM
authors: Gazoni
authors: Kenneth J
authors: KJ
authors: Cherry
authors: Benjamin B
authors: BB
authors: Peeler
authors: Michael
authors: M
authors: Dake
authors: Alan H
authors: AH
authors: Matsumoto
authors: John
authors: J
authors: Angle
authors: Irving L
authors: IL
authors: Kron
authors: Curtis G
authors: CG
authors: Tribble
authors: John A
authors: JA
authors: Kern
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000503:physiopathology / Q000601:surgery*; D001018:Aortic Diseases / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000401:mortality; D020380:Needs Assessment; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D013348:Subclavian Artery / Q000503:physiopathology / Q000601:surgery*; D015996:Survival Rate; D013908:Thoracotomy; D016896:Treatment Outcome