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Related Experiment Video

Updated: May 27, 2026

Novel and Innovative Hybrid Technique for Type A Aortic Dissection
06:26

Novel and Innovative Hybrid Technique for Type A Aortic Dissection

Published on: March 28, 2025

Selective left subclavian ligation in total aortic arch replacement.

Yong Cui1, Fanglin Lu, Lin Han

  • 1Department of Cardiac and Thoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.

The Annals of Thoracic Surgery
|November 15, 2011
PubMed
Summary

Selective ligation of the deep left subclavian artery (LSA) is a safe technique for total aortic arch replacement in Stanford type A aortic dissection patients with insufficient exposure. This method simplifies surgery while maintaining adequate arm perfusion through collateral circulation.

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Encircling the heart, the coronary arteries form a ring-like structure before...

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Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Thoracic Surgery

Background:

  • The left subclavian artery (LSA) can be challenging to manage during total aortic arch replacement, especially with large false lumens in the ascending aorta or right hemiarch.
  • Deeply located LSAs pose significant manipulation difficulties in these complex aortic dissection cases.

Purpose of the Study:

  • To evaluate the safety and efficacy of selectively ligating a deeply located left subclavian artery (LSA) during total aortic arch replacement and stented elephant trunk implantation.
  • To determine if this approach simplifies surgical procedures for Stanford type A aortic dissection.

Main Methods:

  • Retrospective review of 29 patients with deep LSA undergoing total aortic arch replacement and stented elephant trunk implantation (January 2008 - June 2010).

Related Experiment Videos

Last Updated: May 27, 2026

Novel and Innovative Hybrid Technique for Type A Aortic Dissection
06:26

Novel and Innovative Hybrid Technique for Type A Aortic Dissection

Published on: March 28, 2025

  • Selective LSA ligation was performed in cases of difficult exposure, contingent on thorough preoperative and intraoperative assessment of collateral circulation (Circle of Willis, vertebral arteries).
  • Bypass grafting to the left axillary artery was utilized if collateral circulation was deemed insufficient.

    • Main Results:

    • Twenty-eight of 29 patients survived the procedure, with one early death.
    • Postoperative left arm blood pressure was lower (78±17.3 vs 126±3.7 mm Hg), but oxygen saturation, skin temperature, and hand strength remained normal.
    • Follow-up averaged 16.6 months, with no reported cases of LSA steal syndrome or arm ischemia.

    Conclusions:

    • Selective ligation of the left subclavian artery, following rigorous collateral circulation assessment, is a safe and effective strategy for managing deeply located LSAs in Stanford type A aortic dissection.
    • This technique can significantly simplify total aortic arch replacement procedures when surgical exposure is compromised.