Left subclavian artery coverage during emergent TEVAR in a patient with ipsilateral functional arteriovenous fistula

Coverage of the left subclavian artery origin is required to achieve adequate proximal seal during up to 40% of TEVAR cases. The evidence regarding left subclavian artery revascularization in patients undergoing elective or emergent TEVAR with left subclavian artery coverage is weak, and there is ongoing debate whether revascularization should be performed routinely of selectively. Beyond this debate, there is a lack of data about left subclavian artery coverage during TEVAR in end-stage renal disease patients with a functional left upper limb atreriovenous fistula. We present the case of a patient with a left distal radiocephalic arteriovenous fistula who underwent emergent TEVAR with left subclavian artery coverage for ruptured type B aortic dissection. The arteriovenous fistula remains functional on a 3-month follow-up, and the patient did not develop symptoms related to posterior stroke, spinal cord ischemia, limb ischemia, or vertebrobasilar insufficiency.