How to manage the left subclavian artery during endovascular stenting of the thoracic aorta

Syed M Rehman, Joshua A Vecht, Ryan Perera, Rozh Jalil, Srdjan Saso, Jon R Anderson, Ludwig Karl von Segesser, Thanos Athanasiou
European Journal of Cardio-thoracic Surgery 2011, 39 (4): 507-18
We performed a systematic review of the literature to establish whether revascularisation of the left subclavian territory is necessary when this artery is covered by a stent. We retrieved data from 99 studies incorporating 4906 patients. Incidences of left-arm ischaemia (0.0% vs 9.2%, p=0.002) and stroke (4.7% vs 7.2%, p<0.001) were significantly less following revascularisation, although mortality (10.5% vs 3.4%, p=0.032) and endoleak incidence (25.8% vs 12.6%, p=0.008) were increased. No significant differences in spinal-cord ischaemia were seen. Revascularisation may reduce downstream ischaemic complications but can cause significant risk. Indications must be carefully considered on an individual patient basis.

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