title: Less-invasive management of left subclavian artery in stent-grafting for distal aortic arch disease.
abstract: Simple coverage of the left subclavian artery (LSA) in thoracic endovascular aortic repair (TEVAR) is still a controversial procedure. We present our modified strategy dealing with LSA in TEVAR. Hand-made stent grafts were placed more proximal beyond the LSA for 104 patients. In elective 76, preoperative LSA occlusion test was performed on 31 patients, and preoperative computed tomographic angiography (CTA) of the vertebro-basilar artery was performed on the remaining 45. Head vessels were planned to be kept patent using fenestrated stent grafts, if possible. Stent grafts were placed from zone 0 in 23, zone 1 in 39, and zone 2 in 42. The LSA occlusion tests revealed harmful effects, such as loss of consciousness and vertigo in two out of 31 patients (6.5%). Vertebro-basilar arterial CTA revealed possible risks, if LSA covered, in three out of 45 patients (6.7%). Fenestrated stent grafts could successfully preserve 131 head vessels, except for one unintentional occlusion of the left carotid artery (0.75%). There was no LSA-related complication in any of the cases. A combination of preoperative vertebro-basilar arterial CTA and fenestrated stent grafts is useful to avoid possible LSA-related complications in TEVAR.
authors.affiliation: Department of Traumatology and Critical Care Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo 060-8543, Japan. kurimoto@sapmed.ac.jp
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Kurimoto
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Kawaharada
authors.forename: Toshiro
authors.initials: T
authors.lastname: Ito
authors.forename: Toshio
authors.initials: T
authors.lastname: Baba
authors.forename: Syunsuke
authors.initials: S
authors.lastname: Ohori
authors.forename: Atsushi
authors.initials: A
authors.lastname: Watanabe
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Asai
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Higami
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D021721:Balloon Occlusion; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011474:Prosthesis Design; D018570:Risk Assessment; D015607:Stents; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D055815:Young Adult