title: Routine revascularization is unnecessary in the majority of patients requiring zone II coverage during thoracic endovascular aortic repair: a longitudinal outcomes study using United States Medicare population data.
abstract: OBJECTIVE
  We aimed to evaluate outcomes of thoracic endovascular aortic repair (TEVAR) with left subclavian artery (LSA) coverage without bypass (TEVAR + SUB) to TEVAR with coverage of the LSA with a bypass at the time of the initial procedure or later at a separate procedure (TEVAR + SUB + BYPASS).
  
  
  METHODS
  The Centers for Medicare & Medicaid Services inpatient claims for 2006-2007 were queried using Current Procedural Terminology codes for TEVAR, TEVAR + SUB, TEVAR + SUB + BYPASS or later as a separate procedure.
  
  
  RESULTS
  A total of 2676 patients underwent TEVAR; 869 (32.5%) underwent TEVAR + SUB and 49 (5.6%) TEVAR + SUB + BYPASS. At the time of the initial procedure, TEVAR + SUB + BYPASS was associated with a higher incidence of stroke compared to TEVAR + SUB (12.8% vs. 3.8 %; p = 0.0033). Among TEVAR + SUB, only 1.93% (50 patients) had a subsequent bypass performed during a one-year follow-up. Overall rates of morbidity (p = 0.004) and mortality (p = 0.011) trended towards significance in favor of TEVAR + SUB.
  
  
  CONCLUSIONS
  TEVAR + SUB were associated with lower rates of mortality and complications. Only a small percentage of TEVAR + SUB required a bypass at one year after procedure. Our data suggest that routine LSA bypass during TEVAR is unnecessary and associated with increase morbidity and mortality.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, MO, USA.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Wilson
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, MO, USA.
authors.forename: Edgar L
authors.initials: EL
authors.lastname: Galiñanes
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, MO, USA.
authors.forename: Parker
authors.initials: P
authors.lastname: Hu
authors.affiliation: Department of Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: Viktor Y
authors.initials: VY
authors.lastname: Dombrovskiy
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, MO, USA vogeltr@health.missouri.edu.
authors.forename: Todd R
authors.initials: TR
authors.lastname: Vogel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D014487:Centers for Medicare and Medicaid Services, U.S.; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000401:mortality; D013348:Subclavian Artery / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D019564:Unnecessary Procedures
keywords: Thoracic endovascular aortic repair; carotid-subclavian bypass; coverage; endovascular