Comparing endovascular techniques for left subclavian artery revascularization during zone 2 thoracic endovascular aortic repair for type B acute aortic syndromes: a retrospective cohort study

TL;DR

This study compares three endovascular techniques for treating aortic issues and finds they are similarly effective but require monitoring for long-term risks.

Contribution

The study provides a comparative analysis of three endovascular techniques for left subclavian artery revascularization during zone 2 TEVAR in acute aortic syndromes.

Findings

All three techniques showed high technical success rates and similar perioperative complication rates.

No significant differences were observed in mortality, aortic remodeling, or reintervention rates among the groups.

LSA occlusion occurred in all groups, highlighting the need for long-term monitoring.

Abstract

Castor-branched stent-graft, chimney stent, and fenestration techniques have been employed for left subclavian artery (LSA) revascularization during zone 2 thoracic endovascular aortic repair (TEVAR), but not recommended routinely. This study aimed to compare the safety and efficacy of these techniques.

From February 2017 to June 2020, 133 patients with type B acute aortic syndromes undergoing LSA revascularization during zone 2 TEVAR were retrospectively enrolled. The primary outcomes include technical success, mortality, stroke and spinal cord ischemia. The secondary outcomes include aortic remodeling, LSA patency, freedom from aorta-related reintervention.

Fifty patients were treated with the Castor-branched stent-graft (Group A), 42 with the chimney technique (Group B), and 41 with the fenestration technique (Group C). The groups demonstrated a similar technical success rate, with 96% in Group A, 97.62% in Group B, and 95.12% in Group C. Despite a more predominant bird-beak configuration in group A (p = 0.003), no significant difference was observed in perioperative complications. Two TEVAR-related deaths occurred in Groups B and C, while none was reported in Group A. During the first two years of follow-up, favorable aortic remodeling was confirmed in all groups. Each group exhibited two cases of LSA occlusions. Aorta-related reintervention and mortality did not significantly differ among the groups.

Endovascular techniques are feasible for LSA revascularization during zone 2 TEVAR, with favorable aortic remodeling. However, the durability of these procedures requires careful evaluation, given the potential concern of LSA occlusion.

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