title: Coverage of the left subclavian artery without revascularization during thoracic endovascular repair is feasible: a prospective study.
abstract: BACKGROUND
  To effectively isolate thoracic aortic lesions in thoracic endovascular aortic repair (TEVAR), an adequate proximal landing zone length is required. The left subclavian artery (LSCA) and other branches of the aortic arch commonly impose limitations on proximal landing zone length, restricting the use of TEVAR. In this study, we investigated the outcomes of LSCA coverage during TEVAR.
  
  
  METHODS
  Between March 2009 and February 2010, we recruited patients with thoracic dissection, aneurysm or trauma from a single center for TEVAR. We categorized patients into 3 groups: full coverage, partial coverage, or noncoverage of the LSCA. We measured pre- and postoperative blood pressures and evaluated complications during follow-up.
  
  
  RESULTS
  We recruited 111 patients for our study: 55 (50%) and 25 (23%) patients had full and partial LSCA coverage, respectively. The upper left arm blood pressures before and after the operations were significantly different between the full-coverage group and the other groups (P < 0.0001). Follow-up occurred between 6 and 20 months, and the mean follow-up time was 10.4 months. Thirteen patients (24%) in the full-coverage group and 2 patients (8%) in the partial-coverage group suffered from simple vertebrobasilar ischemia (VBI). Eleven of the patients with VBI (20%) in the full-coverage group and 2 (8%) patients with VBI in the partial-coverage group had left subclavian steal syndrome at follow-up. No paraplegia or stroke was observed.
  
  
  CONCLUSIONS
  Intentional coverage of the LSCA to obtain an adequate proximal landing zone for TEVAR can be a treatment option for thoracic aortic lesions, although some patients experienced mil complications.
authors.affiliation: Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiangtong University, Shanghai, China; Vascular Surgery Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: Yi
authors.initials: Y
authors.lastname: Si
authors.affiliation: Vascular Surgery Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China. Electronic address: fu.weiguo@zs-hospital.sh.cn.
authors.forename: Weiguo
authors.initials: W
authors.lastname: Fu
authors.affiliation: Vascular Surgery Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Surgery, University of Wisconsin, Madison, WI; Department of Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, China.
authors.forename: Zhenjie
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of Statistics, University of Wisconsin, Madison, WI.
authors.forename: Chen
authors.initials: C
authors.lastname: Zuo
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: Xudong
authors.initials: X
authors.lastname: Shi
authors.affiliation: Vascular Surgery Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Yuqi
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Vascular Surgery Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Daqiao
authors.initials: D
authors.lastname: Guo
authors.affiliation: Vascular Surgery Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Qin
authors.initials: Q
authors.lastname: Xu
authors.affiliation: Vascular Surgery Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001013:Aorta, Thoracic / Q000293:injuries / Q000503:physiopathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D002681:China; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D012307:Risk Factors; D013348:Subclavian Artery / Q000601:surgery*; D013349:Subclavian Steal Syndrome / Q000209:etiology / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D014715:Vertebrobasilar Insufficiency / Q000209:etiology / Q000503:physiopathology