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Long-Term Outcomes and Patency of Left Carotid-Subclavian Bypass in Thoracic Endovascular Aortic Repair
Giacomo Murana1, Chiara Nocera1, Luca di Marco1,2
1Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, 40138, Italy.
Insights
Left carotid-subclavian bypass (LCSB) remains a safe and effective revascularization strategy for thoracic endovascular aortic repair (TEVAR) patients. This study confirms LCSB
Area of Science:
- Vascular Surgery
- Aortic Surgery
- Endovascular Repair
Background:
- Left carotid-subclavian bypass (LCSB) is a traditional method for left subclavian artery (LSA) revascularization during thoracic endovascular aortic repair (TEVAR).
- The use of LCSB has declined with the rise of endovascular LSA management techniques.
- Limited data exist on LCSB outcomes, particularly regarding graft complications and long-term patency.
Purpose of the Study:
- To evaluate the safety and effectiveness of LCSB in TEVAR patients.
- To analyze graft-related complications and long-term patency rates of LCSB.
- To compare outcomes between elective and urgent LCSB procedures.
Main Methods:
- Retrospective analysis of 161 patients undergoing TEVAR with LCSB (November 2005 - January 2025).
- Comparison of in-hospital outcomes between urgent and elective groups.
- Assessment of LCSB patency via follow-up imaging and Kaplan-Meier survival analysis.
Main Results:
- LCSB was performed in 161 patients, with 22.3% being urgent procedures.
- In-hospital mortality was 3.7% (3.2% elective vs. 5.6% urgent, P=.491).
- Overall LCSB patency was 97.4% at last follow-up, with 5-year patency at 99%; 5-year survival was 87.4%.
Conclusions:
- Left carotid-subclavian bypass is a safe and effective revascularization strategy for the LSA in TEVAR.
- Urgent LCSB procedures did not result in worse in-hospital outcomes compared to elective procedures.
Objectives:
Left carotid-subclavian bypass (LCSB) is a classic strategy for left subclavian artery (LSA) revascularization in thoracic endovascular aortic repair (TEVAR) patients. Its employment has been reduced in recent years due to the advent of endovascular solutions for LSA management. Data on outcomes of LCSB are lacking, especially for graft-related complications and patency at follow-up.
Methods:
All patients who underwent TEVAR with LCSB from November 2005 to January 2025, in an elective or urgent setting, were retrospectively analysed in terms of pre- and intraoperative characteristics, short- and mid-term outcomes. In-hospital outcomes were compared between the urgent and elective groups. LCSB patency at follow-up imaging was reported. A Kaplan-Meier analysis was performed on survival, freedom from reintervention and LCSB patency.
Results:
LCSB was performed in 161 patients, 36 of which (22.3%) were urgent procedures. In-hospital mortality was 3.7%, with no significant difference between the elective and the urgent group (3.2% vs 5.6% respectively, P = .491). There was a not statistically significantly higher incidence of stroke in the urgent patients (0.8% vs 5.6%, P = .057). LCSB-related complications occurred in 12 patients (7.4%). Overall LCSB patency at last available follow-up was 97.4%. LSA embolization was necessary in 7 cases (4.5%) due to type II endoleak. At 5 years, survival was 87.4%, freedom from reintervention was 88.5% and LCSB patency was 99%.
Conclusions:
LCSB is safe and effective as a LSA revascularization strategy. Even in urgent patients, LCSB was not linked to worse in-hospital outcomes.
