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Subclavian artery revascularization with subclavian-carotid transposition for TEVAR and non-TEVAR patients.
- Source :
-
The Journal of cardiovascular surgery [J Cardiovasc Surg (Torino)] 2024 Apr; Vol. 65 (2), pp. 147-154. Date of Electronic Publication: 2023 May 10. - Publication Year :
- 2024
-
Abstract
- Background: Subclavian artery revascularization (SAR) has become an increasingly performed technique in patients undergoing thoracic endovascular aortic aneurysm repair (TEVAR), in order to optimize the proximal landing zone, or in patients with significant atherosclerotic diseases. SAR was usually achieved through carotid-subclavian bypass (CSB) which is daunted by graft and patency-related issues, or through subclavian carotid transposition (SCT) which has recently been reconsidered as a potential solution. Nowadays, multiple endovascular strategies including parallel grafts, chimney graft and branch-fenestrated repair, are available in patients unfit for open SAR. However, there is no consensus on the preferable technique in both TEVAR- and non TEVAR-patients. The purpose of this study was to evaluate our experience with SCT in terms of overall postoperative adverse events and mid-term patency rate.<br />Methods: We performed a retrospective cohort study, including all patients who underwent SCT between June 2014 and March 2020 at our Division. Preoperative risk factors, symptoms, intraoperative details, postoperative outcomes and follow-up data were collected.<br />Results: A total of 27 patients were included in this study. Indications for SCT included aortic arch debranching for TEVAR for thoracic aortic aneurysm and type B dissection and symptomatic subclavian steal syndrome (SSS). There were no major perioperative adverse events or major neurological complications; five minor adverse events occurred (18.5%) (3 Horner' Syndrome, 1 hematoma requiring reoperation,1 pneumothorax). Peripheral nerve injuries and lymphatic lesions were not recorded. On a mean follow-up of 21±16 months, SCT patency was confirmed in all patients and no deaths occurred. Comparison of baseline and operative characteristics and intraoperative details between groups of patients with or without adverse events did not found differences.<br />Conclusions: SCT should be considered a feasible, effective and safe technique for SAR, with low perioperative complications and optimal mid-term patency. This surgical technique appears to provide a lower risk of neurological events and mortality, particularly in TEVAR patients, reducing the complications caused by the coverage of the left subclavian artery.
- Subjects :
- Aged
Female
Humans
Male
Middle Aged
Aortic Dissection surgery
Aortic Dissection diagnostic imaging
Aortic Dissection physiopathology
Blood Vessel Prosthesis
Carotid Arteries surgery
Postoperative Complications etiology
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Aortic Aneurysm, Thoracic surgery
Aortic Aneurysm, Thoracic diagnostic imaging
Aortic Aneurysm, Thoracic physiopathology
Blood Vessel Prosthesis Implantation instrumentation
Blood Vessel Prosthesis Implantation methods
Endovascular Aneurysm Repair methods
Subclavian Artery surgery
Subclavian Artery physiopathology
Subclavian Artery diagnostic imaging
Vascular Patency
Subjects
Details
- Language :
- English
- ISSN :
- 1827-191X
- Volume :
- 65
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- The Journal of cardiovascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 37162237
- Full Text :
- https://doi.org/10.23736/S0021-9509.23.11473-X