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Outcome Comparisons of Direct Coverage Versus Fenestration for an Isolated Left Vertebral Artery in Zone 2 TEVAR: A
Zuo Pu1,2, Kun Fang2, Jingbo Lu1
1Peripheral Vascular Ward (Cardiac Surgery Ward 1), Fuwai Hospital Chinese Academy of Medical Sciences, 518001 Shenzhen, Guangdong, China.
Background:
Thoracic endovascular aortic repair (TEVAR) in Zone 2 frequently necessitates coverage of the isolated left vertebral artery (ILVA), a congenital vascular anomaly, to ensure adequate proximal sealing. However, the clinical requirement of ILVA revascularization remains uncertain. Thus, this study aimed to compare the outcomes between ILVA coverage and fenestration during Zone 2 TEVAR.
Methods:
We retrospectively analyzed the clinical records of patients with ILVA who underwent Zone 2 TEVAR between September 2010 and August 2023. Patients were divided into two groups: Coverage Group (n = 23) and Fenestration Group (n = 33). Baseline characteristics, surgical outcomes, and changes in left and right vertebral artery diameters pre- and postoperatively were compared. Continuous variables were compared using Student's t-test or Mann-Whitney U test, depending on the distribution. Categorical variables were analyzed using the chi-square test or Fisher's exact test.
Results:
The overall cohort had a mean age of 54.48 ± 10.31 years, with 89.29% of participants male and a mean body mass index (BMI) of 25.88 ± 3.5 kg/m2. The Fenestration Group was significantly older than the Coverage Group (56.82 ± 8.78 vs. 51.13 ± 11.56; p = 0.04). Technical success of the TEVAR was achieved in both groups in 98.21% of cases, with no perioperative mortality. Simultaneous left subclavian artery stenting was performed more frequently in the Fenestration Group (57.58% vs. 21.74%; p = 0.008). At discharge, patients in the Coverage Group demonstrated a significantly greater reduction in left vertebral artery diameter compared with the Fenestration Group (13.64% [5.52%, 22.4%] vs. 0 [-3.29%, 5.13%]; p < 0.001). The incidence of vertebral artery diameter reduction was significantly higher in the Coverage Group compared with the Fenestration Group (39.13% vs. 6.06%; p < 0.01). Follow-up computed tomography angiography demonstrated a greater reduction in left vertebral artery diameter in the Coverage Group (52.94% vs. 14.29%; p = 0.020), while occlusion rates were comparable between groups (29.41% vs. 4.76%; p = 0.070).
Conclusions:
Fenestration is associated with a lower incidence of postoperative ILVA diameter reduction compared with direct coverage during Zone 2 TEVAR. These findings highlight the potential benefit of ILVA revascularization and underscore the need for further validation in larger studies.
