Further consideration for subclavian revascularization with TEVAR.

Area of Science:

• Vascular Surgery
• Cardiovascular Interventions
• Aortic Disease Management

Background:

• Management of the left subclavian artery (LSA) during thoracic endovascular aortic repair (TEVAR) remains controversial.
• Recent guidelines suggest routine LSA revascularization, but up to one-third of patients require LSA coverage during TEVAR.
• The LSA's critical role in supplying the upper extremity, spinal cord, and brain necessitates careful consideration of its management.

Purpose of the Study:

• To review and analyze existing data comparing routine versus selective LSA revascularization strategies.
• To provide a focused discussion on the evidence supporting each approach for LSA management during TEVAR.

Main Methods:

• Review of current literature and clinical studies.
• Analysis of data regarding neurologic and upper extremity outcomes associated with LSA sacrifice versus revascularization.
• Evaluation of complication rates for both routine and selective revascularization strategies.

Main Results:

• Studies supporting routine LSA revascularization report higher rates of spinal cord ischemia, stroke, and upper extremity ischemia when the LSA is sacrificed.
• Conversely, studies advocating for selective revascularization show no significant difference in neurologic outcomes and suggest expectant management for upper extremity ischemia.
• Selective revascularization avoids complications associated with LSA revascularization procedures.

Conclusions:

• The optimal management strategy for the left subclavian artery during TEVAR requires careful consideration of individual patient factors and available evidence.
• Further research may be needed to definitively establish the superiority of routine versus selective LSA revascularization in specific patient populations.
• Balancing the risks of LSA sacrifice against the potential complications of revascularization is crucial for patient safety and optimal outcomes.