The Society for Vascular Surgery Practice Guidelines: management of the left subclavian artery with thoracic endovascular aortic repair.
The Society for Vascular Surgery pursued development of clinical practice guidelines for the management of the left subclavian artery with thoracic endovascular aortic repair (TEVAR). In formulating clinical practice guidelines, the society selected a panel of experts and conducted a systematic review and meta-analysis of the literature. They used the grading of recommendations assessment, development, and evaluation (GRADE) method to develop and present their recommendations. The overall quality of evidence was very low. The committee issued three recommendations. Recommendation 1: In patients who need elective TEVAR where achievement of a proximal seal necessitates coverage of the left subclavian artery, we suggest routine preoperative revascularization, despite the very low-quality evidence (GRADE 2, level C). Recommendation 2: In selected patients who have an anatomy that compromises perfusion to critical organs, routine preoperative LSA revascularization is strongly recommended, despite the very low-quality evidence (GRADE 1, level C). Recommendation 3: In patients who need urgent TEVAR for life-threatening acute aortic syndromes where achievement of a proximal seal necessitates coverage of the left subclavian artery, we suggest that revascularization should be individualized and addressed expectantly on the basis of anatomy, urgency, and availability of surgical expertise (GRADE 2, level C).
Matsumura
Jon S
JS
Division of Vascular Surgery, University of Wisconsin, Madison, WI 53792, USA. matsumura@surgery.wisc.edu
Lee
W Anthony
WA
Mitchell
R Scott
RS
Farber
Mark A
MA
Murad
Mohammad Hassan
MH
Lumsden
Alan B
AB
Greenberg
Roy K
RK
Safi
Hazim J
HJ
Fairman
Ronald M
RM
D001013:Aorta, Thoracic / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D001018:Aortic Diseases / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D003097:Collateral Circulation; D017558:Elective Surgical Procedures; D019317:Evidence-Based Medicine; D006801:Humans; D018579:Patient Selection; D011474:Prosthesis Design; D012039:Regional Blood Flow; D018570:Risk Assessment; D015607:Stents; D013348:Subclavian Artery / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome