Rehders Tim C, Petzsch Michael, Ince Huseyin, Kische Stephan, Korber Thomas, Koschyk Dietmar H, Chatterjee Tushar, Weber Frank, Nienaber Christoph A
Department of Internal Medicine, Division of Cardiology, University Hospital Rostock, Germany.
J Endovasc Ther. 2004 Dec;11(6):659-66. doi: 10.1583/04-1311R.1.
To examine the clinical consequences and/or potential need for postinterventional transposition after stent-graft occlusion of the left subclavian artery (LSA).
The records of 171 consecutive patients (128 men; mean age 60.2+/-13.2 years, range 20-83) undergoing elective stent-graft repair in the thoracic aorta were reviewed to identify intentional endograft coverage of the ostial LSA, as documented by transesophageal echocardiography and/or aortography. Patients were treated for subacute type B dissection, true aneurysm, pseudoaneurysm, or previously operated type A dissection with persistent false lumen flow in the descending aorta. Among the 171 cases, 22 (12.9%) patients were identified with stent-graft occlusion of the LSA.
A systolic blood pressure differential existed between the right (138.4+/-14.0 mmHg) and the left (101.8+/-21.0 mmHg; p<0.05) arms after occlusion of the LSA. No patient showed a malperfusion syndrome during postinterventional hospitalization. During a mean follow-up of 24.0+/-15.8 months, 15 (68.2%) patients remained completely asymptomatic, with no functional deficit or temperature differential between the arms, while 7 patients reported mild symptoms of a subclavian steal syndrome. However, no patient required any secondary surgical intervention.
Stent-graft-induced occlusion of the ostial LSA was tolerated by all patients without chronic functional deficit. In the absence of stenotic vertebral and/or carotid arteries and with a documented intact vertebrobasilar system, prophylactic transposition of the LSA is not required prior to intentional stent-graft occlusion of the LSA.
探讨左锁骨下动脉（LSA）支架移植物闭塞后介入治疗后转位的临床后果和/或潜在需求。
回顾171例连续接受胸主动脉择期支架移植物修复术的患者（128例男性；平均年龄60.2±13.2岁，范围20 - 83岁）的记录，以确定经食管超声心动图和/或主动脉造影记录的LSA开口处有意进行的腔内移植物覆盖情况。患者接受治疗的疾病包括亚急性B型夹层、真性动脉瘤、假性动脉瘤或既往接受过手术的A型夹层且降主动脉存在持续性假腔血流。在这171例病例中，22例（12.9%）患者被确定为LSA支架移植物闭塞。
LSA闭塞后，右侧手臂（138.4±14.0 mmHg）和左侧手臂（101.8±21.0 mmHg；p<0.05）之间存在收缩压差异。介入治疗后住院期间，无患者出现灌注不良综合征。在平均24.0±15.8个月的随访期间，15例（68.2%）患者完全无症状，双臂之间无功能缺陷或温度差异，而7例患者报告有锁骨下窃血综合征的轻微症状。然而，无患者需要任何二次手术干预。
所有患者均能耐受支架移植物导致的LSA开口处闭塞，且无慢性功能缺陷。在不存在椎动脉和/或颈动脉狭窄且有记录表明椎基底系统完整的情况下，在有意进行LSA支架移植物闭塞之前，无需预防性转位LSA。
