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

医学 主动脉修补术 血运重建 左锁骨下动脉 心脏病学 锁骨下动脉 外科 内科学 冲程(发动机) 主动脉 主动脉弓 心肌梗塞 机械工程 工程类
作者
Gabriele Piffaretti,Giovanni Pratesi,Guido Gelpi,Mario Galli,Frank J. Criado,Michele Antonello,Federico Fontana,Filippo Piacentino,Edoardo Macchi,Matteo Tozzi,Patrizio Castelli,Matteo Barbante,Arnaldo Ippoliti,Claudia Romagnoni,Carlo Antona,Anita Paggi,Andrea Xodo,Franco Grego
出处
期刊:Journal of Endovascular Therapy [SAGE Publishing]
卷期号:25 (6): 740-749 被引量:33
标识
DOI:10.1177/1526602818802581
摘要

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.
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