Management of left subclavian artery in endovascular stent-grafting for distal aortic arch disease.
BACKGROUND
Although the left subclavian artery (LSA) is simply covered to exclude distal aortic arch aneurysm during endovascular stent-grafting, this technique is potentially harmful.


RESULTS
Between January 2001 and April 2005, 40 cases of stent-grafting were performed for distal aortic arch diseases. For all 31 elective cases, the LSA occlusion test using a balloon catheter was preoperatively performed to predict critical complications secondary to LSA coverage by a stent graft and this revealed 2 cases in which the LSA was crucial for brain circulation (6.5%). The LSA was saved by using a hand-made fenestrated stent graft without bypass-grafting to the LSA in 22 cases. Bypass-grafting to LSA was performed in 5 cases. The LSA was simply occluded in 13 cases. Hospital mortality rates for the elective and emergency cases were 3.2% and 30.0%, respectively. One elective patient had a cerebral infarction (2.5%). LSA patency was successfully maintained in all 22 cases using a fenestrated stent graft.


CONCLUSIONS
The LSA plays an important role in brain circulation in some patients and so a preoperative LSA occlusion test is helpful when aortic stent-grafting is proposed. Fenestrated stent graft saved the LSA in more than 50% of the present cases.
Kurimoto
Yoshihiko
Y
Department of Traumatology and Critical Care Medicine, Sapporo Medical University, Sapporo, Japan. kurimoto@sapmed.ac.jp
Ito
Toshiro
T
Harada
Ryo
R
Hase
Mamoru
M
Kuwaki
Kenji
K
Kawaharada
Nobuyoshi
N
Morishita
Kiyofumi
K
Higami
Tetsuya
T
Asai
Yasufumi
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery*; D013504:Cardiovascular Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D002544:Cerebral Infarction / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome