%0 Journal Article
%T Comparison of Two Different Techniques for Isolated Left Subclavian Artery Revascularization During Thoracic Endovascular Aortic Repair in Zone 2
%A Frank J. Criado
%A Gabriele Piffaretti
%A Giovanni Pratesi
%A Guido Gelpi
%A Mario Galli
%A Michele Antonello
%J Journal of Endovascular Therapy
%@ 1545-1550
%D 2018
%R 10.1177/1526602818802581
%X Purpose: To analyze the results of isolated left subclavian artery (LSA) revascularization during thoracic endovascular aortic repair (TEVAR) using carotid-subclavian bypass (CSbp) or chimney grafts (CGs). Methods: A retrospective multicenter, observational study identified 73 patients (mean age 68¡À13 years, range 22¨C87; 56 men) with acute or chronic thoracic aortic lesions who underwent TEVAR with isolated LSA revascularization using either CSbp (n=42) or CGs (n=31) from January 2010 and February 2017. Primary endpoints were TEVAR-related mortality, postoperative stroke, freedom from type Ia endoleak, and LSA patency. Results: Primary technical success was achieved in all cases. Early TEVAR-related mortality was 4.2% (CSbp 2% vs CG 6%, p=0.571). Two (3%) patients had major ischemic strokes (one in each group). Mean follow-up was 24¡À21 months (range 1¨C72; median 15). Estimated freedom from TEVAR-related mortality was 93%¡À3% (95% CI 84.3% to 97.0%) at 12 and 36 months, with no significant difference between CSbp and CG (p=0.258). Aortic reintervention did not differ between the groups (CSbp 5% vs CG 6%, p=0.356); nor did freedom from type Ia endoleak (CSbp 98% vs CG 87%, p=0.134). Gutter-related endoleaks occurred in 4 (13%) CG patients, but none of the patients experienced sac enlargement or the need for reintervention and none died. Primary patency of the LSA was 100% for the entire group during the observation period. Conclusion: In our experience, LSA revascularization proved most satisfactory and equally effective with both the CSbp and CG techniques, without discernible differences at midterm follow-up
%K carotid-subclavian bypass
%K chimney graft
%K endoleak
%K intramural hematoma
%K left subclavian artery
%K LSA preservation
%K mortality
%K reintervention
%K thoracic aortic aneurysm
%K thoracic aortic disease
%K thoracic endovascular aortic repair
%K type B aortic dissection
%U https://journals.sagepub.com/doi/full/10.1177/1526602818802581