Initial and Mid-term Results of Thoracic Endovascular Repair(TEVAR)―Management of Left Subclavian Artery(LSA)during Zone 2(Z2)Coverage―

(Department of Cardiovascular Surgery, Southern Tohoku General Hospital, Koriyama, Japan)

Hirofumi Midorikawa Megumu Kanno Takashi Takano
Kouyu Watanabe Kyohei Ueno
Between August 2008 and June 2012, 17 TEVAR procedures for thoracic aortic aneurysms(TAA)requiring Z2 coverage were performed at our institution. Patient age ranged from 46 to 82 years old(mean 69.4), 16 were male. Criteria for LSA revascularization at our institution are defined as either:1)dominant left vertebral artery(VA), 2)absent or diminutive or occluded right VA, 3)no communication of bilateral VA, 4)bilateral carotid artery disease, 5)patent LIMA-coronary bypass, 6)if a long length of the thoracic aorta is covered. Devices utilized were Gore TAG(n=12)and TX2(n=5). Deployment of the stent-graft(SG)was successful in 17 cases(100%)and complete thrombosis of the aneurysm or complete entry closure was achieved in 16 cases(94.1%). Axillo-axillar cross over bypass(Ax-Ax B)was performed in 5 cases(29.4%). There was no instance of cerebrospinal ischemia or hospital death and the mean follow-up was 22.9 month(range 5 to 46). One case was converted to open surgery due to secondary type 1 endoleak. There was no instance of Ax-Ax B graft occlusion or aneurysmal rupture. The initial and mid-term results of TEVAR requiring Z2 coverage were satisfactory, and we believe that our criteria for LSA revascularization played an important role in providing the satisfactory results.
  Jpn. J. Cardiovasc. Surg. 42:6-10(2013)

Keywords:thoracic endovascular aortic repair, left subclavian artery, zone 2