title: Results with a selective revascularization strategy for left subclavian artery coverage during thoracic endovascular aortic repair.
abstract: BACKGROUND
  The need for routine left subclavian artery (LSCA) revascularization when this vessel is covered during thoracic endovascular aortic repair remains controversial. We report our results with a selective LSCA revascularization strategy during thoracic endovascular aortic repair.
  
  
  METHODS
  Between May 2002 and March 2010, 287 thoracic endovascular aortic repair procedures were performed at our institution. LSCA coverage occurred in 145 (51%), which form the basis of this report.
  
  
  RESULTS
  Left subclavian artery revascularization was performed in 32 patients (22%) through a left common carotid-LSCA bypass. Indications for selective LSCA revascularization included spinal cord protection in 10, patent pedicled left internal mammary artery graft in 9, left arm ischemia after LSCA coverage in 5, origin of the left vertebral artery from the arch in 4, dialysis access in the left arm in 2, and vertebrobasilar insufficiency in 2. There were no instances of dominant left vertebral artery. The revascularized and non-revascularized groups had similar rates of death (6.3% vs 1.8%; p=0.21), stroke (3.1% vs 3.5%; p>0.99), permanent paraplegia or paraparesis (3.1% vs 0%; p=0.22), and type II endoleak (4.3% vs 6.5%; p>0.99). There were no instances of ischemic stroke related to left posterior circulation hypoperfusion. Four complications of carotid-subclavian bypass occurred in 3 patients (9.4%).
  
  
  CONCLUSIONS
  Selective LSCA revascularization is safe and does not appear to increase the risk of neurologic events. Further, subclavian revascularization is not without complications, which should be considered with regards to a nonselective revascularization strategy.
authors: Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors: Teng C
authors: TC
authors: Lee
authors: Nicholas D
authors: ND
authors: Andersen
authors: Judson B
authors: JB
authors: Williams
authors: Syamal D
authors: SD
authors: Bhattacharya
authors: Richard L
authors: RL
authors: McCann
authors: G Chad
authors: GC
authors: Hughes
mesh_terms: D000368:Aged; D000792:Angiography / Q000379:methods; D017130:Angioplasty / Q000379:methods*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009204:Myocardial Revascularization / Q000379:methods*; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D013348:Subclavian Artery / Q000503:physiopathology / Q000601:surgery*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome