Intentional Occlusion of the Left Subclavian Artery During Stent-Graft Implantation in the Thoracic Aorta:Risk and Relevance

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Abstract
Purpose: To examine the clinical consequences and/or potential need for postinterventional transposition after stent-graft occlusion of the left subclavian artery (LSA). Methods: The records of 171 consecutive patients (128 men; mean age 60.2±13.2 years, range 20–83) undergoing elective stent-graft repair in the thoracic aorta were reviewed to identify intentional endograft coverage of the ostial LSA, as documented by transesophageal echocardiography and/or aortography. Patients were treated for subacute type B dissection, true aneurysm, pseudoaneurysm, or previously operated type A dissection with persistent false lumen flow in the descending aorta. Among the 171 cases, 22 (12.9%) patients were identified with stent-graft occlusion of the LSA. Results: A systolic blood pressure differential existed between the right (138.4±14.0 mmHg) and the left (101.8±21.0 mmHg; pConclusions: Stent-graft—induced occlusion of the ostial LSA was tolerated by all patients without chronic functional deficit. In the absence of stenotic vertebral and/or carotid arteries and with a documented intact vertebrobasilar system, prophylactic transposition of the LSA is not required prior to intentional stent-graft occlusion of the LSA.