Management of the Left Subclavian Artery during Endovascular Stent Grafting for Traumatic Aortic Injury – A Systematic Review

Abstract Objectives and design Traumatic thoracic aortic injuries are serious and may be associated with high morbidity and mortality. Endovascular stent grafting is now an established treatment option which often requires proximal landing zone extension through left subclavian artery (LSA) origin c...

Full description

Saved in:
Bibliographic Details
Published in:European journal of vascular and endovascular surgery 2011-06, Vol.41 (6), p.758-769
Main Authors: Sepehripour, A.H, Ahmed, K, Vecht, J.A, Anagnostakou, V, Suliman, A, Ashrafian, H, Darzi, A, Athanasiou, T
Format: Article
Language:English
Subjects:
Angioplasty
Aorta
Aorta, Thoracic - injuries
Aorta, Thoracic - surgery
Blood Vessel Prosthesis Implantation
Endovascular
Humans
Stent graft
Stents
Subclavian artery
Subclavian Artery - surgery
Surgery
Thoracic
Trauma
Vascular System Injuries - surgery
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract Objectives and design Traumatic thoracic aortic injuries are serious and may be associated with high morbidity and mortality. Endovascular stent grafting is now an established treatment option which often requires proximal landing zone extension through left subclavian artery (LSA) origin coverage. This in turn can lead to downstream ischaemic complications which may be lessened by LSA revascularisation. This study investigates the consequence of LSA coverage and potential benefit of revascularisation. Materials and methods Systematic literature review of studies between 1997 and 2010 identified 94 studies incorporating 1704 patients. Chronological trends in LSA management practice for trauma were sought. Designated outcomes of interest were prevalences of left arm ischaemia, stroke, spinal cord ischaemia, endoleak, stent migration, need for additional procedure and mortality. These outcomes were compared in patients with and without LSA coverage (taking account of the degree of coverage). The impact of revascularisation on these outcomes was also explored. Statistical analysis included examination with Chi-Square or Fisher’s tests as appropriate. Results Isolated total LSA coverage without revascularisation increases the prevalence of left arm ischaemia [prevalence of 4.06% versus 0.0% ( p  
ISSN:1078-5884
1532-2165
DOI:10.1016/j.ejvs.2011.01.007