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Left subclavian artery coverage during TEVAR: is revascularization necessary?
1Unit of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY 10016, USA.
The Journal of Cardiovascular Surgery
|March 30, 2012
Summary
Thoracic endovascular aortic repair (TEVAR) often requires left subclavian artery (LSA) coverage. This review compares routine versus selective LSA revascularization to determine the optimal management strategy for TEVAR patients.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Thoracic Surgery
Background:
- Thoracic endovascular aortic repair (TEVAR) is a common treatment for various aortic pathologies.
- Left subclavian artery (LSA) coverage is frequently necessary during TEVAR for proximal seal.
- Management strategies for LSA coverage remain debated, with potential risks like stroke and paraplegia.
Purpose of the Study:
- To review and compare literature on routine versus selective left subclavian artery (LSA) revascularization following thoracic endovascular aortic repair (TEVAR).
- To determine the optimal management strategy for LSA coverage during TEVAR.
Main Methods:
- Literature review comparing outcomes of routine LSA revascularization versus selective LSA revascularization.
- Analysis of studies examining morbidity associated with LSA coverage in TEVAR.
Main Results:
- Studies supporting routine revascularization link LSA coverage to increased risks of stroke, paraplegia, and arm ischemia.
- Other studies indicate intentional LSA coverage without revascularization is not associated with increased morbidity, supporting selective approaches.
Conclusions:
- The optimal management strategy for LSA coverage during TEVAR is controversial.
- Selective LSA revascularization may be appropriate in specific patient subgroups, such as those with patent LIMA-coronary bypass or dominant vertebral arteries.
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