Abstract | OBJECTIVE: The primary purpose of the current study was to evaluate the safety and effectiveness of selective coverage of the left subclavian artery (LSCA) without revascularization during thoracic endovascular aortic repair ( TEVAR) in patients with bilateral patent vertebrobasilar junctions. The secondary purpose was to assess morphologic change of the vertebral artery (VA) after the procedure. METHODS: Among 126 patients who underwent TEVAR between 2006 and 2011, 29 patients requiring LSCA coverage without preemptive revascularization were retrospectively analyzed in this study. The patients were a mean age of 63.1 years (range, 45-84 years). The mean follow-up period was 19.9 months (range, 1-63 months). Bilateral patent vertebrobasilar junctions were evaluated by contrast-enhanced computed tomography (CT), time-of flight magnetic resonance angiography, or conventional angiography. Neurologic complications, such as spinal cord ischemia (SCI) or cerebrovascular accidents, were analyzed. Preprocedural and postprocedural changes in VAs were evaluated on follow-up contrast-enhanced CT. RESULTS: The overall 30-day mortality was 6.9% (2 of 29). None of the patients had SCI or a stroke of posterior circulation alone. Cerebrovascular accidents from embolic infarctions occurred in two patients (7.4%). Transient left arm ischemic symptoms were present in five patients (18.5%), but none required secondary interventions. Delayed development of type I endoleak occurred due to stent deformity in one patient, who underwent surgery. One patient required reintervention after the 10-month follow-up contrast-enhanced CT showed a pseudoaneurysm had developed at the distal margin of the previously placed stent graft. Hypertrophy of the right VA after TEVAR was seen in seven of 27 patients (25.9%); two patients showed bilateral hypertrophy of VAs. CONCLUSIONS: LSCA coverage without revascularization can be safely performed during TEVAR in patients with bilateral patent vertebrobasilar junctions. Hypertrophy of the right VA was noted in 25.9% of patients after LSCA coverage.
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Authors | Minwook Lee, Do Yun Lee, Man-Deuk Kim, Jong Yun Won, Young-Nam Yune, Taek Yeon Lee, Donghoon Choi, Young-Guk Ko |
Journal | Journal of vascular surgery
(J Vasc Surg)
Vol. 57
Issue 5
Pg. 1311-6
(May 2013)
ISSN: 1097-6809 [Electronic] United States |
PMID | 23357520
(Publication Type: Journal Article)
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Copyright | Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved. |
Topics |
- Aged
- Aged, 80 and over
- Aorta, Thoracic
(diagnostic imaging, physiopathology, surgery)
- Aortic Diseases
(diagnostic imaging, mortality, physiopathology, surgery)
- Aortography
(methods)
- Blood Vessel Prosthesis
- Blood Vessel Prosthesis Implantation
(adverse effects, instrumentation, mortality)
- Endovascular Procedures
(adverse effects, instrumentation, mortality)
- Female
- Humans
- Magnetic Resonance Angiography
- Male
- Middle Aged
- Postoperative Complications
(physiopathology, therapy)
- Prosthesis Design
- Retrospective Studies
- Stents
- Subclavian Artery
(diagnostic imaging, physiopathology, surgery)
- Time Factors
- Tomography, X-Ray Computed
- Treatment Outcome
- Vascular Patency
- Vertebral Artery
(diagnostic imaging, physiopathology)
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