PURPOSE: To investigate the extent to which clinical status is affected by covering the left subclavian artery (LSA) with stent-grafts in the thoracic aorta. METHODS: Stent-graft reconstruction of the thoracic aorta was performed in 23 patients (20 men; mean age 50.8 years, range 17-77) for management of rupture (n = 11), type B dissection (n = 9), or aneurysm (n = 3). All patients had bilaterally equal systolic and diastolic blood pressures (141.3+/-19.8 and 78.9+/-11.0 mmHg, respectively). Twenty Gore TAG and 1 Talent thoracic endografts were used; 2 cases required a combination of prostheses. In all patients, the stent-graft was intentionally placed to cover the LSA. Follow-up included clinical examination with blood pressure measurements and computed tomography during the first postoperative week and at 3-month intervals thereafter. RESULTS: After coverage of the LSA by the stent-graft, systolic pressure fell by a mean 48.3+/-23.4 mmHg. In 4 cases of proximal endoleak, however, systolic pressure fell by only 25.0+/-15.0 mmHg. Twenty (78.5%) patients reported no complaints during a mean follow-up of 12.1+/-7.3 months. Postinterventional complaints reported by 3 patients included exercise-dependent paresthesias; nonexercise-dependent, intermittent, and completely reversible dizziness; and a temperature difference between the upper extremities with no decrease in strength. CONCLUSIONS: Covering the LSA is generally well tolerated by patients and increases the landing zone for the placement of thoracic stent-grafts. Long-term studies, however, must investigate the hemodynamic effects of this procedure on the vertebrobasilar circulation.
PURPOSE: To investigate the extent to which clinical status is affected by covering the left subclavian artery (LSA) with stent-grafts in the thoracic aorta. METHODS: Stent-graft reconstruction of the thoracic aorta was performed in 23 patients (20 men; mean age 50.8 years, range 17-77) for management of rupture (n = 11), type B dissection (n = 9), or aneurysm (n = 3). All patients had bilaterally equal systolic and diastolic blood pressures (141.3+/-19.8 and 78.9+/-11.0 mmHg, respectively). Twenty Gore TAG and 1 Talent thoracic endografts were used; 2 cases required a combination of prostheses. In all patients, the stent-graft was intentionally placed to cover the LSA. Follow-up included clinical examination with blood pressure measurements and computed tomography during the first postoperative week and at 3-month intervals thereafter. RESULTS: After coverage of the LSA by the stent-graft, systolic pressure fell by a mean 48.3+/-23.4 mmHg. In 4 cases of proximal endoleak, however, systolic pressure fell by only 25.0+/-15.0 mmHg. Twenty (78.5%) patients reported no complaints during a mean follow-up of 12.1+/-7.3 months. Postinterventional complaints reported by 3 patients included exercise-dependent paresthesias; nonexercise-dependent, intermittent, and completely reversible dizziness; and a temperature difference between the upper extremities with no decrease in strength. CONCLUSIONS: Covering the LSA is generally well tolerated by patients and increases the landing zone for the placement of thoracic stent-grafts. Long-term studies, however, must investigate the hemodynamic effects of this procedure on the vertebrobasilar circulation.
Authors: Lakshmi A Ratnam; Richard M Walkden; Graham J Munneke; Robert A Morgan; Anna-Maria Belli Journal: Eur Radiol Date: 2008-04-17 Impact factor: 5.315
Authors: D Kirk Lawlor; Michael Ott; Thomas L Forbes; Stewart Kribs; Kenneth A Harris; Guy DeRose Journal: Can J Surg Date: 2005-08 Impact factor: 2.089