title: Management of left subclavian artery in endovascular stent-grafting for distal aortic arch disease.
abstract: 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.
authors.affiliation: Department of Traumatology and Critical Care Medicine, Sapporo Medical University, Sapporo, Japan. kurimoto@sapmed.ac.jp
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Kurimoto
authors.forename: Toshiro
authors.initials: T
authors.lastname: Ito
authors.forename: Ryo
authors.initials: R
authors.lastname: Harada
authors.forename: Mamoru
authors.initials: M
authors.lastname: Hase
authors.forename: Kenji
authors.initials: K
authors.lastname: Kuwaki
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Kawaharada
authors.forename: Kiyofumi
authors.initials: K
authors.lastname: Morishita
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Higami
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Asai
mesh_terms: 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