gms | German Medical Science

Background: Covering the left subclavian artery may be mandatory in some cases to achieve a safe seal zone. Revascularization of the left subclavian artery was one of the procedures done to decrease the stroke rate and spinal cord ischemia but it was debatable due to the morbidity associated with such surgical procedure.

Methods: Between July 2014 and April 2020, twenty-three patients were treated for thoracic aortic pathology (dissection, aneurysm, or penetrating ulcer) by an aortic endograft (TEVAR), in them all the left subclavian artery was covered to ensure a safe proximal seal zone. Routine spinal fluid drainage was done, together with intraoperative monitoring for spinal fluid pressure keeping spinal fluid pressure <10–15 mmHg, keeping the spinal catheter in place for 48 hours with monitoring of the pressure. They were observed and followed up for six months.

Results: This was a retrospective case series study. Data was obtained from twenty-three patients who underwent TEVAR for thoracic aortic dissection (73.91%), thoracic aortic aneurysm (21.74%), or ulcer (4.35%). Planning was based upon multi-slice computed tomographic angiography and covering the left subclavian was mandatory to achieve a proximal sealing zone. Technical success was achieved in 100% of cases. 4.35% of patients had three endograft, 56.52% had two endografts, 39.13% had one endograft. All patients lost their radial pulsations immediately after implantation, 8.70% developed post implantation syndrome (fever) that was managed conservatively, 4.35% developed stroke related to the anterior circulation, 4.35% developed signs of spinal cord ischemia. During the follow up, one patient died within 6 hours after the procedure due to extensive myocardial infarction (patient was scheduled for CABG after our procedure). 17.40% developed upper limb symptoms that were tolerable and were managed conservatively.

Conclusion: By adopting routine spinal cord drainage and pressure monitoring, we can consider not to revascularize the left subclavian artery prior to TEVAR if it will be covered.