Results With a Selective Revascularization Strategy for Left Subclavian Artery Coverage During Thoracic Endovascular Aortic Repair
Results With a Selective Revascularization Strategy for Left Subclavian Artery Coverage During Thoracic Endovascular Aortic Repair
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DOI：
10.1016/j.athoracsur.2011.03.089
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发表时间：
2011-07-01
影响因子：
4.6
通讯作者：
Hughes, G. Chad
中科院分区：
文献类型：
--
作者：
Lee, Teng C.;Andersen, Nicholas D.;Hughes, G. Chad
背景资料。在胸主动脉腔内修复术中，当左锁骨下动脉(LSCA)被覆盖时，是否需要常规的左锁骨下动脉(LSCA)血管重建仍然存在争议。我们报告了在胸主动脉腔内修复术中选择性LSCA血运重建策略的结果。2002年5月至2010年3月，我所共施行了287例胸主动脉腔内修复术。LSCA覆盖145例(51%)，构成本报告的基础。32例患者(22%)通过左侧颈总动脉-LSCA搭桥术进行了左锁骨下动脉血运重建术。选择性LSCA血运重建指征：脊髓保护10例，带蒂左内乳动脉移植9例，LSCA覆盖术后左臂缺血5例，左侧椎动脉起源于弓部4例，左臂透析通畅2例，椎基底动脉供血不足2例。血运重建组和非血运重建组的死亡率相似(6.3%比1.8%；p=0.21)，卒中(3.1%比3.5%；p>；0.99)，永久性截瘫或截瘫(3.1%比0%；p=0.22)，以及II型内漏(4.3%比6.5%；p>；0.99)。未发现与左后循环低灌流有关的缺血性卒中病例。颈动脉-锁骨下动脉搭桥术发生4例并发症3例(9.4%)。选择性LSCA血运重建是安全的，似乎不会增加神经系统事件的风险。此外，锁骨下血管重建术并非没有并发症，对于非选择性的血管重建术，应该考虑这一点。(Ann Thorac Surg 2011；92：97-103)(C)2011年，胸外科医师学会
Background. The need for routine left subclavian artery (LSCA) revascularization when this vessel is covered during thoracic endovascular aortic repair remains controversial. We report our results with a selective LSCA revascularization strategy during thoracic endovascular aortic repair.Methods. Between May 2002 and March 2010, 287 thoracic endovascular aortic repair procedures were performed at our institution. LSCA coverage occurred in 145 (51%), which form the basis of this report.Results. Left subclavian artery revascularization was performed in 32 patients (22%) through a left common carotid-LSCA bypass. Indications for selective LSCA revascularization included spinal cord protection in 10, patent pedicled left internal mammary artery graft in 9, left arm ischemia after LSCA coverage in 5, origin of the left vertebral artery from the arch in 4, dialysis access in the left arm in 2, and vertebrobasilar insufficiency in 2. There were no instances of dominant left vertebral artery. The revascularized and non-revascularized groups had similar rates of death (6.3% vs 1.8%; p = 0.21), stroke (3.1% vs 3.5%; p > 0.99), permanent paraplegia or paraparesis (3.1% vs 0%; p = 0.22), and type II endoleak (4.3% vs 6.5%; p > 0.99). There were no instances of ischemic stroke related to left posterior circulation hypoperfusion. Four complications of carotid-subclavian bypass occurred in 3 patients (9.4%).Conclusions. Selective LSCA revascularization is safe and does not appear to increase the risk of neurologic events. Further, subclavian revascularization is not without complications, which should be considered with regards to a nonselective revascularization strategy. (Ann Thorac Surg 2011;92:97-103) (C) 2011 by The Society of Thoracic Surgeons