INTRODUCTION: The aim of our study was to examine the peri-operative outcomes of carotid-subclavian bypass or transposition (CS-BpTp) versus endovascular techniques (ETs) for left subclavian artery (LSA) revascularization during non-traumatic zone 2 thoracic endovascular aortic repair (TEVAR). METHODS: We used prospectively collected data from the Society for Vascular Surgery Vascular Quality Initiative (VQI) to identify patients who had undergone TEVAR at participating centers (2013-2018). Patients were eligible for inclusion if they had undergone non-traumatic zone 2 TEVAR and concomitant LSA revascularization. Our main exposure of interest was LSA revascularization technique, CS-BpTp or any ET. If a patient underwent multiple TEVAR procedures during the study period, the first case involving zone 2 was used for analysis. Pre-operative patient characteristics were reviewed between treatment groups. The primary outcomes were mortality, transient ischemic attack (TIA)/stroke, and spinal cord ischemia (SCI). All outcomes were assessed up to 30-days post-operatively. RESULTS: A total of 837 patients were included in the study. The pathologies most frequently treated were aneurysm in 248 (34%) and dissection in 326 (45%). Overall, 721 subjects (86%) underwent CS-BpTp while 116 subjects (16%) underwent ETs. The latter included the following techniques: 23 chimney grafts (CGs), 3 scallops, 15 fenestrated grafts, and 75 branched grafts. Mortality was equal at 3% for both groups (p=.67). The rate of TIA/stroke was not significantly different in both groups (5.5% vs 5%, p=.78). Similarly, the rate of SCI was 3% in the entire cohort without significant differences seen between treatment groups (p=1). Multivariate logistic regression could not identify either CS-BpTp or ETs as independent predictors for death or TIA/stroke. CONCLUSION: Within VQI, LSA revascularization during non-traumatic zone 2 TEVAR is safely and effectively achieved with either CS-BpTp or ETs across all non-traumatic thoracic aortic diseases. These techniques appear to be associated with similar peri-operative outcomes in selected patients with low rates of mortality and major neurologic morbidity. Further prospective studies are warranted to elucidate the durability of ETs as compared with CS-BpTp in the long-term.
INTRODUCTION: The aim of our study was to examine the peri-operative outcomes of carotid-subclavian bypass or transposition (CS-BpTp) versus endovascular techniques (ETs) for left subclavian artery (LSA) revascularization during non-traumatic zone 2 thoracic endovascular aortic repair (TEVAR). METHODS: We used prospectively collected data from the Society for Vascular Surgery Vascular Quality Initiative (VQI) to identify patients who had undergone TEVAR at participating centers (2013-2018). Patients were eligible for inclusion if they had undergone non-traumatic zone 2 TEVAR and concomitant LSA revascularization. Our main exposure of interest was LSA revascularization technique, CS-BpTp or any ET. If a patient underwent multiple TEVAR procedures during the study period, the first case involving zone 2 was used for analysis. Pre-operative patient characteristics were reviewed between treatment groups. The primary outcomes were mortality, transient ischemic attack (TIA)/stroke, and spinal cord ischemia (SCI). All outcomes were assessed up to 30-days post-operatively. RESULTS: A total of 837 patients were included in the study. The pathologies most frequently treated were aneurysm in 248 (34%) and dissection in 326 (45%). Overall, 721 subjects (86%) underwent CS-BpTp while 116 subjects (16%) underwent ETs. The latter included the following techniques: 23 chimney grafts (CGs), 3 scallops, 15 fenestrated grafts, and 75 branched grafts. Mortality was equal at 3% for both groups (p=.67). The rate of TIA/stroke was not significantly different in both groups (5.5% vs 5%, p=.78). Similarly, the rate of SCI was 3% in the entire cohort without significant differences seen between treatment groups (p=1). Multivariate logistic regression could not identify either CS-BpTp or ETs as independent predictors for death or TIA/stroke. CONCLUSION: Within VQI, LSA revascularization during non-traumatic zone 2 TEVAR is safely and effectively achieved with either CS-BpTp or ETs across all non-traumatic thoracic aortic diseases. These techniques appear to be associated with similar peri-operative outcomes in selected patients with low rates of mortality and major neurologic morbidity. Further prospective studies are warranted to elucidate the durability of ETs as compared with CS-BpTp in the long-term.
Authors: Mario D'Oria; Kevin Mani; Randall DeMartino; Martin Czerny; Konstantinos P Donas; Anders Wanhainen; Sandro Lepidi Journal: Interact Cardiovasc Thorac Surg Date: 2021-05-10