Clinical Outcomes of Left Subclavian Artery Coverage on Morbidity and Mortality During Thoracic Endovascular Aortic Repair for Distal Arch Aneurysms.

backgroundThis single-center study assessed left subclavian artery (LSA) revascularization management and morbidity and mortality of LSA coverage outcomes during elective thoracic endovascular aortic repair (TEVAR) for distal arch aneurysms.

methodsBetween July 2006 and June 2014, 178 patients underwent TEVAR (zone 2 + 3) for distal arch aneurysms. TEVAR with LSA coverage (zone 2) was performed in 121 patients (68.0 %). Multivariate analysis was performed to determine factors associated with perioperative cerebral infarction (CI) and postoperative endoleak (EL).

resultsTechnical success was achieved in 96.7 %. LSA coil embolization was performed in 72.7 %. Subclavian artery crossover bypass was required in 9.1 %. Perioperative complications were CI (6.6 %) and paraplegia (1.7 %). The 30-day mortality rate was 2.5 % (n = 3). There were significant differences by CI univariate analysis in coverage range (≥300 mm) (P = 0.003) and shaggy aorta (P = 0.044). Primary EL occurred in 14.0 % (n = 17). We found statistically significant difference of primary EL in chronic obstructive pulmonary disease (P = 0.016), preoperative aneurysm diameter (P = 0.041), and proximal stent graft diameter (P = 0.029). Left upper extremity symptoms developed in 5.8 % (n = 7); vertebrobasilar insufficiency occurred in 4.1 % (n = 5). Freedom from secondary intervention rates after 1, 3, and 5 years were 96.1, 78.3, and 63.4 %, respectively.

conclusionsOur mid- to long-term results of TEVAR with LSA coverage were generally acceptable. Routine revascularization was not necessary in majority of zone 2 TEVAR. CI occurred in approximately 6 % of the cases, secondary interventions were performed more often for ELs.