Contrella Benjamin N, Sabri Saher S, Tracci Margaret C, Stone James R, Kern John A, Upchurch Gilbert R, Matsumoto Alan H, Angle John F
Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22908.
Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22908.
J Vasc Interv Radiol. 2015 Nov;26(11):1609-14. doi: 10.1016/j.jvir.2015.07.022. Epub 2015 Aug 31.
To report outcomes of coverage of the left subclavian artery (LSCA) during thoracic endovascular aortic repair (TEVAR).
A retrospective review was performed of 285 patients (160 male) with a mean age of 62 years (range, 13-91 y) who underwent TEVAR at a single institution between March 2005 and May 2013. The LSCA was covered to obtain an adequate proximal landing zone, and a selective LSCA revascularization and embolization strategy was employed. All patient outcomes were recorded including neurologic complications, left arm claudication, endoleak rates, and repeat procedures.
The origin of the LSCA was covered in 98/285 (34%) patients. Median follow-up was 533 days (range, 2-2,895 d). Cerebrovascular accident (CVA) rates for covered LSCA and noncovered groups were 11/98 (11%) and 5/188 (3%), respectively (P = .005). LSCA was revascularized at time of initial TEVAR in 44/98 (45%) patients. Of the remaining 54 patients, 10 (19%) required subsequent revascularization for claudication. LSCA embolization was done to prevent or treat endoleak in 41/98 (42%) patients, with 33/98 (34%) patients undergoing LSCA embolization at the time of LSCA coverage and 8 of the remaining 65 (12%) patients requiring subsequent embolization for persistent endoleak.
Coverage of the LSCA during TEVAR is feasible with low complication rates, although it carries an increased risk of CVA. The selective LSCA revascularization and embolization strategy was well tolerated. A more liberal strategy may be required to decrease the rate of delayed revascularization and embolization procedures to treat arm claudication and endoleaks, respectively.
报告胸主动脉腔内修复术（TEVAR）期间左锁骨下动脉（LSCA）覆盖的结果。
对2005年3月至2013年5月在单一机构接受TEVAR治疗的285例患者（160例男性）进行回顾性研究，平均年龄62岁（范围13 - 91岁）。为获得足够的近端锚定区而覆盖LSCA，并采用选择性LSCA血运重建和栓塞策略。记录所有患者的结局，包括神经系统并发症、左臂间歇性跛行、内漏发生率和再次手术情况。
98/285（34%）例患者的LSCA起始部被覆盖。中位随访时间为533天（范围2 - 2895天）。LSCA被覆盖组和未被覆盖组的脑血管意外（CVA）发生率分别为11/98（11%）和5/188（3%）（P = 0.005）。44/98（45%）例患者在初次TEVAR时对LSCA进行了血运重建。在其余54例患者中，10例（19%）因间歇性跛行需要后续血运重建。41/98（42%）例患者进行了LSCA栓塞以预防或治疗内漏，其中33/98（34%）例患者在覆盖LSCA时进行了LSCA栓塞，其余65例中的8例（12%）患者因持续性内漏需要后续栓塞。
TEVAR期间覆盖LSCA是可行的，并发症发生率低，尽管其CVA风险增加。选择性LSCA血运重建和栓塞策略耐受性良好。可能需要更宽松的策略来分别降低治疗手臂间歇性跛行和内漏的延迟血运重建和栓塞手术的发生率。
