Management strategies for thoracic stent-graft repair of distal aortic arch lesions: is intentional subclavian artery occlusion a safe procedure?

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• 作者：Fabrizio Fanelli ; Michael D. Dake ; Filippo Maria Salvatori ; Armando Pucci ; Giuseppe Mazzesi ; Pierleone Lucatelli ; Plinio Rossi and Roberto Passariello
• 关键词：Aorta ; Thoracic aneurysm ; Stent ; graft ; Aortic dissection
• 刊名：European Radiology
• 出版年：2009
• 出版时间：October, 2009
• 年：2009
• 卷：19
• 期：10
• 页码：2407-2415
• 全文大小：187.1 KB

文摘

The aim of this retrospective analysis was to assess the clinical consequences after intentional left subclavian artery (LSA) occlusion. Thirty-seven patients, 27 type B dissection and 10 thoracic aneurysm, with short proximal neck (less than 2 cm) underwent endovascular treatment with intentional exclusion of LSA origin. No immediate complications occurred. Mean arterial pressure gradient, between right and left arms, ranged from 15 to 45 mmHg. After a mean follow-up of 43.70 ¡À 24.01 months, mild left arm symptoms secondary to flow reduction occurred in eight cases (21.6 % ) but only one required LSA transposition, after 8 months, for visual impairment. Type II endoleaks from excluded LSA occurred in 10 cases (27.0 % ): in seven patients, leaks were treated with coils and/or glue embolization; in one case, leak sealed spontaneously; one patient died before leak embolization could occur; one patient refused any further treatment. Intentional exclusion of the LSA may be justified when a longer proximal landing zone in the aortic arch is required.