Left Subclavian Artery To Left Common Carotid Artery Bypass for TEVAR, Does It Make Difference?

Background: Thoracic endovascular aortic repair (TEVAR) is often accompanied with subclavian artery revascularization. The short-term results of individuals undergoing carotid to subclavian artery bypass in this clinical context, however, are not well documented.
Objectives: This study aimed to compare the left subclavian artery to the left common carotid artery bypass for TEVAR.
Methods: 21 patients with different etiologies of aortic pathologies underwent left subclavian artery (LSA) revascularization through cervical -sub clavicular incisions using 8 Fr Dacron graft and TEVAR either simultaneously or as a staged operation. Demographic data, operative procedures, and postoperative data were gathered.
Results: 18 patient were males and 3 were females with mean age of 57 ± 12 years. 12 patients with hypertension. Main pathology was aortic dissection 12 patients, 5 patients had aortic aneurysm with mean aortic diameter of 5.37 ± 1.7 mm penetrating ulcer or intramural hematoma were the least, only 4 patients. Mean operative time 3.6 ±1.2 hours. TEVAR was done either simultaneously in 9 cases or as staged procedure in 12 cases. Only 2 cases of post-operative stroke with no evidence of spinal cord ischemia only one case with postoperative bleeding, but no spinal cord or peripheral nerve injury, no chylous leak and no hematoma. We had only 2 cases of superficial wound infection treated conservatively. Postoperative ICU stay was about 86.1 ± 50 hrs and total hospital stay was about 8.9 ± 2.9 days .
Conclusion: When used in conjunction with TEVAR, carotid-subclavian bypass surgery for subclavian artery revascularization was safe, advantageous, and dramatically reduced the risk of stroke after TEVAR.