Further Consideration for Subclavian Revascularization with TEVAR

被引:20
作者
Garg, Karan [1 ]
Maldonado, Thomas S. [1 ]
机构
[1] NYU, Sch Med, Langone Med Ctr, Dept Surg, New York, NY 10016 USA
关键词
ENDOVASCULAR AORTIC REPAIR; ARTERY COVERAGE; PERIOPERATIVE STROKE; ANEURYSM REPAIR; RISK-FACTORS; BYPASS; STEAL;
D O I
10.1053/j.semvascsurg.2012.09.009
中图分类号
R61 [外科手术学];
学科分类号
摘要
Management of the left subclavian artery (LSA) during thoracic endovascular aortic repair (TEVAR) continues to be controversial, despite recent guidelines submitted by the Society for Vascular Surgery recommending routine revascularization of the LSA in most circumstances. Up to one third of patients require coverage of the LSA during TEVAR. The LSA provides extensive circulation to the upper extremity, spinal cord, and brain, consequently, sacrifice of this great vessel might not be physiologically tolerated. Studies supporting routine preoperative revascularization of the LSA note increased rates of spinal cord ischemia, strokes, and upper extremity ischemia when the LSA is sacrificed. Other studies supporting a selective revascularization strategy note no difference in neurologic outcomes and recommend expectant management of upper extremity ischemia. In addition, LSA revascularization has associated complications that are avoided by selective revascularization. The purpose of this article is to review and focus the available data in support of routine versus selective LSA revascularization. Semin Vasc Surg 25:232-237 (C) 2012 Elsevier Inc. All rights reserved.
引用
收藏
页码:232 / 237
页数:6
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