Comparison of Two Different Techniques for Isolated Left Subclavian Artery Revascularization During Thoracic Endovascular Aortic Repair in Zone 2

J Endovasc Ther. 2018 Dec;25(6):740-749. doi: 10.1177/1526602818802581. Epub 2018 Oct 4.


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±13 years, range 22-87; 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±21 months (range 1-72; median 15). Estimated freedom from TEVAR-related mortality was 93%±3% (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.

Keywords: LSA preservation; carotid-subclavian bypass; chimney graft; endoleak; intramural hematoma; left subclavian artery; mortality; reintervention; thoracic aortic aneurysm; thoracic aortic disease; thoracic endovascular aortic repair; type B aortic dissection.

Publication types

  • Comparative Study
  • Multicenter Study
  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Aortic Aneurysm, Thoracic / diagnostic imaging
  • Aortic Aneurysm, Thoracic / mortality
  • Aortic Aneurysm, Thoracic / surgery*
  • Aortic Dissection / diagnostic imaging
  • Aortic Dissection / mortality
  • Aortic Dissection / surgery*
  • Blood Vessel Prosthesis
  • Blood Vessel Prosthesis Implantation / adverse effects
  • Blood Vessel Prosthesis Implantation / instrumentation
  • Blood Vessel Prosthesis Implantation / methods*
  • Blood Vessel Prosthesis Implantation / mortality
  • Endovascular Procedures / adverse effects
  • Endovascular Procedures / instrumentation
  • Endovascular Procedures / methods*
  • Endovascular Procedures / mortality
  • Female
  • Humans
  • Italy
  • Male
  • Middle Aged
  • Postoperative Complications / etiology
  • Retrospective Studies
  • Risk Factors
  • Subclavian Artery / diagnostic imaging
  • Subclavian Artery / surgery*
  • Time Factors
  • Treatment Outcome
  • Young Adult