title: How to manage the left subclavian artery during endovascular stenting of the thoracic aorta.
abstract: We performed a systematic review of the literature to establish whether revascularisation of the left subclavian territory is necessary when this artery is covered by a stent. We retrieved data from 99 studies incorporating 4906 patients. Incidences of left-arm ischaemia (0.0% vs 9.2%, p=0.002) and stroke (4.7% vs 7.2%, p<0.001) were significantly less following revascularisation, although mortality (10.5% vs 3.4%, p=0.032) and endoleak incidence (25.8% vs 12.6%, p=0.008) were increased. No significant differences in spinal-cord ischaemia were seen. Revascularisation may reduce downstream ischaemic complications but can cause significant risk. Indications must be carefully considered on an individual patient basis.
authors.affiliation: Department of Cardiothoracic Surgery, St. Mary's Hospital-Imperial Healthcare Trust, Praed Street, London W2 1NY, UK.
authors.forename: Syed M
authors.initials: SM
authors.lastname: Rehman
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Vecht
authors.forename: Ryan
authors.initials: R
authors.lastname: Perera
authors.forename: Rozh
authors.initials: R
authors.lastname: Jalil
authors.forename: Srdjan
authors.initials: S
authors.lastname: Saso
authors.forename: Jon R
authors.initials: JR
authors.lastname: Anderson
authors.forename: Ludwig Karl
authors.initials: LK
authors.lastname: von Segesser
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D015424:Reperfusion / Q000379:methods; D015427:Reperfusion Injury / Q000517:prevention & control; D015607:Stents; D013348:Subclavian Artery / Q000601:surgery*; D055815:Young Adult