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  1. Home
  3. Endovascular Versus Surgical Left Subclavian Artery Revascularization With Thoracic Endovascular Aortic Repair Involving The Aortic Arch.
  1. Home
  3. Endovascular Versus Surgical Left Subclavian Artery Revascularization With Thoracic Endovascular Aortic Repair Involving The Aortic Arch.

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Endovascular versus surgical left subclavian artery revascularization with thoracic endovascular aortic repair

Isaac Naazie1, Harneet Sandhu2, Hasan Dosluoglu1

  • 1Division of Vascular Surgery, Department of Surgery, State University of New York at Buffalo, Buffalo, NY.

Journal of Vascular Surgery
|February 27, 2025

View abstract on PubMed

Summary
This summary is machine-generated.

Endovascular techniques and surgical methods for left subclavian artery (LSA) revascularization during thoracic endovascular aortic repair (TEVAR) showed similar outcomes for mortality, stroke, and survival. Endovascular approaches had fewer perioperative reinterventions overall.

Keywords:
Left subclavian artery revascularizationThoracic aortic aneurysmsThoracic aortic dissections

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Area of Science:

  • Cardiovascular Surgery
  • Endovascular Interventions
  • Aortic Aneurysm Repair

Background:

  • Left subclavian artery (LSA) revascularization is often necessary for thoracic endovascular aortic repair (TEVAR) to ensure adequate sealing.
  • The comparative effectiveness of endovascular versus surgical LSA revascularization techniques remains an area of active clinical investigation.

Purpose of the Study:

  • To evaluate the comparative effectiveness of endovascular techniques versus surgical methods for LSA revascularization in patients undergoing TEVAR.
  • To compare outcomes including mortality, stroke, reinterventions, and survival between the two revascularization approaches.

Main Methods:

  • A retrospective analysis of the Vascular Quality Initiative database from August 2014 to November 2023.
  • Included patients undergoing TEVAR for descending thoracic aortic aneurysms (DTAAs) and type B aortic dissections (TBADs) requiring LSA revascularization.
  • Compared surgical LSA revascularization with various endovascular techniques using univariate and multivariable analyses.

    • Main Results:

    • No significant differences were observed in 30-day mortality, perioperative stroke, stroke or death, spinal cord ischemia, or arm ischemia between surgical and endovascular LSA revascularization.
    • Overall perioperative reinterventions were higher in the surgical group (10.7%) compared to the endovascular group (6.1%), though endoleak-specific reinterventions were higher in the endovascular group.
    • One-year reintervention rates and 8-year survival were similar between both groups.

    Conclusions:

    • Endovascular and surgical LSA revascularization techniques demonstrate comparable safety and efficacy in patients undergoing TEVAR for DTAA or TBAD.
    • Endovascular approaches were associated with lower rates of overall perioperative reinterventions.
    • Factors such as Black race, symptomatic presentation, prior coronary revascularization, and prior aneurysm repair were predictors of perioperative reinterventions.