Summary:
Endovascular repair is rapidly becoming the treatment of choice for thoracic
aortic disease, which often, up to 40% of cases, involves or lies in close
proximity to the left subclavian artery (LSA). In order to extend the proximal
landing zone for the stent-graft and obtain an adequate seal, the LSA ostium if
often covered, with or without concomitant subclavian artery revascularization.
Spinal cord ischemia (SCI), cerebrovascular accidents (CVA) and left arm
ischemia remain major complications after thoracic endovascular aortic repair
(TEVAR)with LSA coverage. The LSA provides extensive circulation to the upper
extremity, spinal cord, and brain, consequently, sacrifice of this great vessel
might not be physioligically tolerated. Indeed, coverage of the LSA during
TEVAR is associated with an increased risk of these complications. Contemporary
literature suggests revascularization reduces the risk of neurologic
complications and, specifically, of spinal cord ischemia even though the need
for routine preoperative revascularization remains controversial. Coverage of
the LSA without revascularization may be justified only in emergency
sitiuations or when thorough investigations of the cerebral, vertebro-basilar,
and spinal circulations have concluded that no or minimal risk exists to brain
or spinal cord. Otherwise, routine preoperative revascularization is suggested
in all elective cases especially in the presence of certain indications. All
these are discussed in detail in this current study.
Keywords:
TEVAR, LSA coverage, Complications , LSA revascularization, Thoracic aortic disease
