Partial subclavian artery coverage in TEVAR patients for acute type B aortic dissections: an alternative solution

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Endovascular Therapy

Background:

• Acute type B aortic dissection involving the left subclavian artery (LSA) typically requires endovascular coverage with various revascularization strategies.
• Conservative management often fails, necessitating alternative endovascular solutions for complex dissections.

Purpose of the Study:

• To evaluate the safety and efficacy of partial LSA coverage as an alternative endovascular approach for acute type B aortic dissection.
• To assess outcomes in patients with limited seal zones (<2 cm) requiring LSA coverage.

Main Methods:

• Three patients with acute type B aortic dissection underwent thoracic endovascular repair with partial LSA coverage.
• Eligibility criteria included failure of conservative management and specific indications like ischemia or rupture.

Main Results:

• All three procedures achieved technical success with percutaneous delivery.
• No deaths, aortic ruptures, myocardial infarctions, conversions to open repair, or spinal cord ischemia occurred within 30 days.
• Complete freedom from re-intervention was observed in all patients.

Conclusions:

• Partial LSA coverage may be a viable alternative for acute type B aortic dissection, particularly in cases with small seal zones.
• Further extensive research is required due to the small sample size, limited follow-up, and absence of a comparison group.