Related Experiment Video
Updated: Dec 29, 2025
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Carotid-axillary bypass as an alternative revascularization method for zone II thoracic endovascular aortic repair
Oana Bartos1, Migdat Mustafi1, Mateja Andic1
1Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany.
Insights
Carotid-axillary bypass (CAB) offers a safe alternative for left subclavian artery revascularization during thoracic endovascular aortic repair. This method demonstrates favorable mid-term results with low complication rates, making it a viable option compared to traditional debranching procedures.
Area of Science:
- Vascular Surgery
- Cardiovascular Interventions
- Aortic Disease Management
Background:
- Thoracic endovascular aortic repair (TEVAR) often requires revascularization of the left subclavian artery (LSA).
- Traditional debranching procedures can be associated with significant local complications.
- Carotid-axillary bypass (CAB) has emerged as a potential alternative for LSA revascularization in zone II TEVAR.
Purpose of the Study:
- To evaluate the mid-term clinical outcomes of carotid-axillary bypass (CAB) for left subclavian artery (LSA) revascularization in patients undergoing zone II thoracic endovascular aortic repair (TEVAR).
- To compare the local complication rates of CAB with those of classic debranching procedures.
Main Methods:
- Retrospective, single cohort study of 69 patients undergoing zone II TEVAR with CAB for LSA revascularization (March 2015 - December 2018).
- Assessment of clinical outcomes including local complications, subclavian steal, arm ischemia, paraplegia, mortality, and stroke.
- Follow-up computed tomography scans analyzed for CAB and vertebral artery (VA) patency and LSA thrombus formation.
Main Results:
- In-hospital mortality was 3%, and perioperative stroke rate was 4%.
- Bypass patency was 97% at a mean follow-up of 333 days; VA occlusion occurred in 6%.
- Local complications were low, with no observed phrenic/vagus nerve lesions or chyle leakage. Arm claudication occurred in 3% due to bypass thrombosis.
Conclusions:
- Carotid-axillary bypass (CAB) is a safe and effective alternative for LSA revascularization in zone II TEVAR.
- CAB offers advantages in terms of reduced local complication rates compared to conventional debranching techniques.
- The procedure demonstrates good mid-term patency and acceptable clinical outcomes.
Background:
We investigated the mid-term results of carotid-axillary bypass (CAB) in the setting of zone II thoracic endovascular aortic repair as an alternative method for the left subclavian artery (LSA) revascularization.
Methods:
Our retrospective, single cohort study included all 69 patients from March 2015 to December 2018 with zone II thoracic endovascular aortic repair and CAB for the revascularization of the LSA. Demographics and clinical data were collected. We assessed several clinical outcomes: local complications (hematoma, injury of the brachial plexus, vagus and sympathetic chain nerve palsies, chyle leakage), subclavian steal, arm ischemia, paraplegia, mortality, and stroke. Follow-up computed tomography scans were analyzed for CAB and vertebral artery (VA) patency and the extent of thrombus formation in the LSA.
Results:
The in-hospital mortality was 3% and the perioperative stroke rate was 4%. Permanent paraplegia occurred in 3%. Perioperative morbidity included irritation of the brachial plexus (1%), sympathetic chain nerve palsy (1%), and wound hematoma in 3% of the cases. Phrenic and vagus nerve lesions and chyle leakage were not observed. Bypass patency was 97% at mean follow-up of 333 ± 39 days. VA occlusion was found in 6% of all cases. Strokes did not occur during the follow-up. Morbidity at follow-up included arm claudication (3%) in two patients with bypass thrombosis. Subclavian steal was observed in 3%. The LSA ostium was ligated (44%), plugged (22%), or left open (35%) in patients without a type II endoleak. Subgroup analysis of LSA thrombosis to the level of the VA was more prevalent after surgical ligature (P = .02), but had no negative effects on CAB or VA patency or stroke.
Conclusions:
CAB is a safe alternative to classic debranching procedures, with distinctive advantages regarding local complication rates described in the literature.
