Management strategies for thoracic stent-graft repair of distal aortic arch lesions: is intentional subclavian artery occlusion a safe procedure?
The aim of this retrospective analysis was to assess the clinical consequences after intentional left subclavian artery (LSA) occlusion. Thirty-seven patients, 27 type B dissection and 10 thoracic aneurysm, with short proximal neck (less than 2 cm) underwent endovascular treatment with intentional exclusion of LSA origin. No immediate complications occurred. Mean arterial pressure gradient, between right and left arms, ranged from 15 to 45 mmHg. After a mean follow-up of 43.70 + or - 24.01 months, mild left arm symptoms secondary to flow reduction occurred in eight cases (21.6%) but only one required LSA transposition, after 8 months, for visual impairment. Type II endoleaks from excluded LSA occurred in 10 cases (27.0%): in seven patients, leaks were treated with coils and/or glue embolization; in one case, leak sealed spontaneously; one patient died before leak embolization could occur; one patient refused any further treatment. Intentional exclusion of the LSA may be justified when a longer proximal landing zone in the aortic arch is required.
Department of Radiological Sciences, University of Rome "La Sapienza", 324 Viale Regina Elena, 00161, Rome, Italy. fabrizio.fanelli@uniroma1.it
Fabrizio
F
Fanelli
Michael D
MD
Dake
Filippo Maria
FM
Salvatori
Armando
A
Pucci
Giuseppe
G
Mazzesi
Pierleone
P
Lucatelli
Plinio
P
Rossi
Roberto
R
Passariello
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging* / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D015607:Stents; D013349:Subclavian Steal Syndrome; D016896:Treatment Outcome