title: Intentional left subclavian artery coverage during thoracic endovascular aortic repair for traumatic aortic injury.
abstract: BACKGROUND
  Thoracic endovascular aortic repair (TEVAR) is widely used for treatment of traumatic aortic injury (TAI). Stent graft coverage of the left subclavian artery (LSA) may be required in up to 40% of patients. We evaluated the long-term effects of intentional LSA coverage (LSAC) on symptoms and return to normal activity in TAI patients compared with a similarly treated group whose LSA was uncovered (LSAU).
  
  
  METHODS
  Patients were identified from a prospective institutional trauma registry between September 2005 and July 2012. TAI was confirmed using computed tomography angiography. The electronic medical records, angiograms, and computed tomography angiograms were reviewed in a retrospective fashion. In-person or telephone interviews were conducted using the SF-12v2 (Quality Metrics, Lincoln, RI) to assess quality of life. An additional questionnaire was used to assess specific LSA symptoms and the ability to return to normal activities. Data were analyzed by Spearman rank correlation and multiple linear and logistic regression analysis with appropriate transformations using SAS software (SAS Institute, Cary, NC).
  
  
  RESULTS
  During the study period, 82 patients (57 men; mean age 40.5 ± 20 years, mean Injury Severity Score, 34 ± 10.0) underwent TEVAR for treatment of TAI. Among them, LSAC was used in 32 (39.5%) and LSAU in 50. A group of the LSAU patients (n = 22) served as matched controls in the analysis. We found no statistically significant difference in SF-12v2 physical health scores (ρ = -0.08; P = .62) between LSAC and LSAU patients. LSAC patients had slightly better mental health scores (ρ = 0.62; P = .037) than LSAU patients. LSAC patients did not have an increased likelihood of experiencing pain (ρ = -0.0056; P = .97), numbness (ρ = -0.12; P = .45), paresthesia (ρ = -0.11; P = .48), fatigue (ρ = -0.066; P = .69), or cramping (ρ = -0.12; P = .45). We found no difference between groups in the ability to return to activities. The mean follow-up time was 3.35 years. Six LSAC patients (19%) died during the follow-up period of unrelated causes.
  
  
  CONCLUSIONS
  Intentional LSAC during TEVAR for TAI appears safe, without compromising mental or physical health outcomes. Furthermore, LSAC does not increase the long-term risk of upper extremity symptoms or impairment of normal activities.
authors: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, and Memorial Hermann Heart & Vascular Institute, Houston, Tex.
authors: Cameron L
authors: CL
authors: McBride
authors: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, and Memorial Hermann Heart & Vascular Institute, Houston, Tex.
authors: Joseph J
authors: JJ
authors: Dubose
authors: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, and Memorial Hermann Heart & Vascular Institute, Houston, Tex.
authors: Charles C
authors: CC
authors: Miller
authors: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, and Memorial Hermann Heart & Vascular Institute, Houston, Tex.
authors: Alexa P
authors: AP
authors: Perlick
authors: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, and Memorial Hermann Heart & Vascular Institute, Houston, Tex.
authors: Kristofer M
authors: KM
authors: Charlton-Ouw
authors: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, and Memorial Hermann Heart & Vascular Institute, Houston, Tex.
authors: Anthony L
authors: AL
authors: Estrera
authors: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, and Memorial Hermann Heart & Vascular Institute, Houston, Tex.
authors: Hazim J
authors: HJ
authors: Safi
authors: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, and Memorial Hermann Heart & Vascular Institute, Houston, Tex. Electronic address: ali.azizzadeh@uth.tmc.edu.
authors: Ali
authors: A
authors: Azizzadeh
mesh_terms: D000328:Adult; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology; D011474:Prosthesis Design; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D013781:Texas; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D055815:Young Adult