title: Further consideration for subclavian revascularization with TEVAR.
abstract: Management of the left subclavian artery (LSA) during thoracic endovascular aortic repair (TEVAR) continues to be controversial, despite recent guidelines submitted by the Society for Vascular Surgery recommending routine revascularization of the LSA in most circumstances. Up to one third of patients require coverage of the LSA during TEVAR. The LSA provides extensive circulation to the upper extremity, spinal cord, and brain, consequently, sacrifice of this great vessel might not be physiologically tolerated. Studies supporting routine preoperative revascularization of the LSA note increased rates of spinal cord ischemia, strokes, and upper extremity ischemia when the LSA is sacrificed. Other studies supporting a selective revascularization strategy note no difference in neurologic outcomes and recommend expectant management of upper extremity ischemia. In addition, LSA revascularization has associated complications that are avoided by selective revascularization. The purpose of this article is to review and focus the available data in support of routine versus selective LSA revascularization.
authors.affiliation: Department of Surgery, NYU Langone Medical Center, New York, NY 10016, USA.
authors.forename: Karan
authors.initials: K
authors.lastname: Garg
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Maldonado
mesh_terms: D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D057510:Endovascular Procedures / Q000009:adverse effects; D019317:Evidence-Based Medicine; D006801:Humans; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D018570:Risk Assessment; D012307:Risk Factors; D013348:Subclavian Artery / Q000601:surgery*; D016896:Treatment Outcome