Narrative review on endovascular techniques for left subclavian artery revascularization during thoracic endovascular aortic repair and risk factors for postoperative stroke. 2021

Mario D'Oria, and Kevin Mani, and Randall DeMartino, and Martin Czerny, and Konstantinos P Donas, and Anders Wanhainen, and Sandro Lepidi
Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.

The aim of this study was to present a narrative review on endovascular techniques (ET) for revascularization of the left subclavian artery (LSA) during zone 2 thoracic endovascular aortic repair (TEVAR) and on risk factors for postoperative stroke following TEVAR procedures. Non-systematic search of the literature from the PubMed, Ovid and Scopus databases to identify relevant English-language articles fully published in the period 1 January 2010-1 August 2020. Current general agreement is that LSA revascularization should be always attempted in the elective setting. Under urgent circumstances, it can be delayed but might be considered during the same session on a case-by-case basis. Three ET are currently available: (i) chimney/snorkels (also known as parallel grafts), (ii) fenestrations or branches and (iii) proximal scallops. The main issue with ET is the potential for increased peri-operative stroke risk owing to increased manipulation within the aortic arch. Also, they are relatively novel and further assessment of their long-term durability is needed. Intra-operative embolism and loss of left vertebral artery perfusion are hypothesized as the main causes of stroke in patients undergoing TEVAR. The overall risk of stroke seems higher without LSA revascularization during zone 2 TEVAR. As LSA revascularization might have a direct effect in preventing posterior stroke, it should be routinely performed in elective cases, while a case-by-case evaluation can be made under urgent circumstances. While ET can provide effective options for LSA revascularization during zone 2 TEVAR, they are novel and need further durability assessment. Stroke after TEVAR is a multifactorial pathological process and preventing TEVAR-related cerebral injury remains a significant unmet clinical need.

UI MeSH Term Description Entries
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001013 Aorta, Thoracic The portion of the descending aorta proceeding from the arch of the aorta and extending to the DIAPHRAGM, eventually connecting to the ABDOMINAL AORTA. Aorta, Ascending,Aorta, Descending,Aortic Arch,Aortic Root,Arch of the Aorta,Descending Aorta,Sinotubular Junction,Ascending Aorta,Thoracic Aorta,Aortic Roots,Arch, Aortic,Ascending Aortas,Junction, Sinotubular,Root, Aortic,Sinotubular Junctions
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D012307 Risk Factors An aspect of personal behavior or lifestyle, environmental exposure, inborn or inherited characteristic, which, based on epidemiological evidence, is known to be associated with a health-related condition considered important to prevent. Health Correlates,Risk Factor Scores,Risk Scores,Social Risk Factors,Population at Risk,Populations at Risk,Correlates, Health,Factor, Risk,Factor, Social Risk,Factors, Social Risk,Risk Factor,Risk Factor Score,Risk Factor, Social,Risk Factors, Social,Risk Score,Score, Risk,Score, Risk Factor,Social Risk Factor
D013348 Subclavian Artery Artery arising from the brachiocephalic trunk on the right side and from the arch of the aorta on the left side. It distributes to the neck, thoracic wall, spinal cord, brain, meninges, and upper limb. Arteries, Subclavian,Artery, Subclavian,Subclavian Arteries
D013997 Time Factors Elements of limited time intervals, contributing to particular results or situations. Time Series,Factor, Time,Time Factor
D016896 Treatment Outcome Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series. Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes
D057510 Endovascular Procedures Minimally invasive procedures, diagnostic or therapeutic, performed within the BLOOD VESSELS. They may be perfomed via ANGIOSCOPY; INTERVENTIONAL MAGNETIC RESONANCE IMAGING; INTERVENTIONAL RADIOGRAPHY; or INTERVENTIONAL ULTRASONOGRAPHY. Endovascular Techniques,Intravascular Procedures,Intravascular Techniques,Endovascular Procedure,Endovascular Technique,Intravascular Procedure,Intravascular Technique,Procedure, Endovascular,Procedure, Intravascular,Procedures, Endovascular,Procedures, Intravascular,Technique, Endovascular,Technique, Intravascular,Techniques, Endovascular,Techniques, Intravascular
D019917 Blood Vessel Prosthesis Implantation Surgical insertion of BLOOD VESSEL PROSTHESES to repair injured or diseased blood vessels. Implantation, Blood Vessel Prosthesis,Vascular Prosthesis Implantation,Implantation, Vascular Prosthesis,Prosthesis Implantation, Vascular
D020521 Stroke A group of pathological conditions characterized by sudden, non-convulsive loss of neurological function due to BRAIN ISCHEMIA or INTRACRANIAL HEMORRHAGES. Stroke is classified by the type of tissue NECROSIS, such as the anatomic location, vasculature involved, etiology, age of the affected individual, and hemorrhagic vs. non-hemorrhagic nature. (From Adams et al., Principles of Neurology, 6th ed, pp777-810) Apoplexy,Cerebral Stroke,Cerebrovascular Accident,Cerebrovascular Apoplexy,Vascular Accident, Brain,CVA (Cerebrovascular Accident),Cerebrovascular Accident, Acute,Cerebrovascular Stroke,Stroke, Acute,Acute Cerebrovascular Accident,Acute Cerebrovascular Accidents,Acute Stroke,Acute Strokes,Apoplexy, Cerebrovascular,Brain Vascular Accident,Brain Vascular Accidents,CVAs (Cerebrovascular Accident),Cerebral Strokes,Cerebrovascular Accidents,Cerebrovascular Accidents, Acute,Cerebrovascular Strokes,Stroke, Cerebral,Stroke, Cerebrovascular,Strokes,Strokes, Acute,Strokes, Cerebral,Strokes, Cerebrovascular,Vascular Accidents, Brain

Related Publications

Mario D'Oria, and Kevin Mani, and Randall DeMartino, and Martin Czerny, and Konstantinos P Donas, and Anders Wanhainen, and Sandro Lepidi
January 2018, Annals of vascular surgery,
Mario D'Oria, and Kevin Mani, and Randall DeMartino, and Martin Czerny, and Konstantinos P Donas, and Anders Wanhainen, and Sandro Lepidi
January 2023, Frontiers in cardiovascular medicine,
Mario D'Oria, and Kevin Mani, and Randall DeMartino, and Martin Czerny, and Konstantinos P Donas, and Anders Wanhainen, and Sandro Lepidi
June 2019, Annals of vascular diseases,
Mario D'Oria, and Kevin Mani, and Randall DeMartino, and Martin Czerny, and Konstantinos P Donas, and Anders Wanhainen, and Sandro Lepidi
March 2024, Cardiovascular and interventional radiology,
Mario D'Oria, and Kevin Mani, and Randall DeMartino, and Martin Czerny, and Konstantinos P Donas, and Anders Wanhainen, and Sandro Lepidi
April 2020, The Journal of thoracic and cardiovascular surgery,
Mario D'Oria, and Kevin Mani, and Randall DeMartino, and Martin Czerny, and Konstantinos P Donas, and Anders Wanhainen, and Sandro Lepidi
January 2013, Journal of vascular surgery,
Mario D'Oria, and Kevin Mani, and Randall DeMartino, and Martin Czerny, and Konstantinos P Donas, and Anders Wanhainen, and Sandro Lepidi
October 2007, The Annals of thoracic surgery,
Mario D'Oria, and Kevin Mani, and Randall DeMartino, and Martin Czerny, and Konstantinos P Donas, and Anders Wanhainen, and Sandro Lepidi
December 2018, Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists,
Mario D'Oria, and Kevin Mani, and Randall DeMartino, and Martin Czerny, and Konstantinos P Donas, and Anders Wanhainen, and Sandro Lepidi
October 2018, Zhonghua wai ke za zhi [Chinese journal of surgery],
Mario D'Oria, and Kevin Mani, and Randall DeMartino, and Martin Czerny, and Konstantinos P Donas, and Anders Wanhainen, and Sandro Lepidi
October 2011, Journal of vascular surgery,
Copied contents to your clipboard!