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

BACKGROUND: This 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.

METHODS: Between 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).

RESULTS: Technical 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.

CONCLUSIONS: Our 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.