title: Meta-analysis of Left Subclavian Artery Coverage With and Without Revascularization in Thoracic Endovascular Aortic Repair.
abstract: OBJECTIVE
  To examine the role of left subclavian artery (LSA) revascularization in thoracic endovascular aortic repair (TEVAR) with LSA coverage.
  
  
  METHODS
  A systematic search was conducted to identify all studies providing comparative outcomes with or without LSA revascularization for LSA occlusion during TEVAR. The search included MEDLINE, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials, the World Health Organization International Clinical Trials Registry, ClinicalTrials.gov, ISRCTN Register, and bibliographic reference lists. The primary outcome parameters were perioperative stroke, spinal cord ischemia (SCI), and mortality. Combined overall effect sizes were calculated using fixed effect or random effects models; results are reported as the odds ratio (OR) and 95% confidence interval (CI).
  
  
  RESULTS
  Five observational studies reporting a total of 1161 patients were identified; 444 patients underwent LSA revascularization and the remaining 717 patients did not. LSA revascularization was associated with a similar risk of stroke (OR 0.70, 95% CI 0.43 to 1.14, p=0.15), SCI (OR 0.56, 95% CI 0.28 to 1.10, p=0.09), and mortality (OR 0.87, 95% CI 0.55 to 1.39, p=0.56) compared with no LSA revascularization.
  
  
  CONCLUSIONS
  LSA revascularization was not found to significantly reduce neurologic complications or mortality in patients undergoing TEVAR with coverage of the LSA origin. Randomized clinical trials are required to elucidate the role of routine or selective LSA revascularization in these cases.
authors.affiliation: Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: Shahin
authors.initials: S
authors.lastname: Hajibandeh
authors.affiliation: Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: Shahab
authors.initials: S
authors.lastname: Hajibandeh
authors.affiliation: Department of General Surgery, University Hospital of Heraklion, University of Crete, Heraklion, Greece.
authors.forename: Stavros A
authors.initials: SA
authors.lastname: Antoniou
authors.affiliation: Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: Francesco
authors.initials: F
authors.lastname: Torella
authors.affiliation: Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK antoniou.ga@hotmail.com.
authors.forename: George A
authors.initials: GA
authors.lastname: Antoniou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D016009:Chi-Square Distribution; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012307:Risk Factors; D015607:Stents; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
keywords: carotid-subclavian bypass; left subclavian artery; mortality; revascularization; spinal cord ischemia; stroke; thoracic aortic aneurysm; thoracic aortic dissection; thoracic endovascular aortic repair