Department of Cardiovascular Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
Ann Thorac Cardiovasc Surg. 2021 Aug 20;27(4):251-259. doi: 10.5761/atcs.oa.20-00166. Epub 2020 Dec 18.
More evidence was required to guide the management of left subclavian artery (LSA) during thoracic endovascular aortic repair (TEVAR). The present study aimed to compare the outcomes of LSA coverage with LSA revascularization. Another purpose of this study was to share our experience of LSA revascularization with castor single-branched stent-graft.
From January 2016 to December 2019, 134 patients with type B aortic dissection (TBAD) or intramural hematoma (IMH) were enrolled and divided into two groups, the LSA-covered group (n = 61) and the LSA-revascularized group (with castor single-branched stent-graft, n = 73). The results, such as in-hospital and 30-day mortality, stroke, paraplegia, left arm ischemia, operation time, endoleak, were compared between the two groups.
The incidence of 30-day stroke in the LSA-covered group (8.2%) was significantly higher compared with the LSA-revascularized group (0%, P = 0.018). 30-day ischemia of left arm occurred in more patients in the LSA-covered group (11.5%, P = 0.003). No statistical difference was found in the incidences of paraplegia, endoleak, in-hospital mortality, and 30-day mortality.
LSA should be revascularized during TEVAR to reduce the incidences of stroke and left arm ischemia. Castor single-branched stent-graft was feasible and safe for treating TBAD or IMH.
在胸主动脉腔内修复术（TEVAR）期间，需要更多的证据来指导左锁骨下动脉（LSA）的处理。本研究旨在比较 LSA 覆盖与 LSA 血运重建的结果。本研究的另一个目的是分享我们使用蓖麻单分支支架移植物进行 LSA 血运重建的经验。
2016 年 1 月至 2019 年 12 月，共纳入 134 例 B 型主动脉夹层（TBAD）或壁内血肿（IMH）患者，分为 LSA 覆盖组（n = 61）和 LSA 血运重建组（使用蓖麻单分支支架移植物，n = 73）。比较两组患者的住院和 30 天死亡率、卒中、截瘫、左臂缺血、手术时间、内漏等结果。
LSA 覆盖组 30 天卒中发生率（8.2%）明显高于 LSA 血运重建组（0%，P = 0.018）。LSA 覆盖组更多的患者发生 30 天左臂缺血（11.5%，P = 0.003）。截瘫、内漏、住院死亡率和 30 天死亡率的发生率无统计学差异。
TEVAR 时应进行 LSA 血运重建，以降低卒中和左臂缺血的发生率。蓖麻单分支支架移植物治疗 TBAD 或 IMH 是可行和安全的。
