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Left Subclavian Artery Occlusion During TEVAR in the Elderly is Associated with Significant Morbidity
Khanjan H. Nagarsheth, MD, Jonathan Schor, MD, Matthew D'Alessandro, DO, Kuldeep Singh, MD, Jonathan Deitch, MD.
Staten Island University Hospital, Staten Island, NY, USA.

Covering the left subclavian artery (LSA) during thoracic endovascular aortic repair (TEVAR) for proximal seal is generally safe and well tolerated. The purpose of this study is to determine if this practice is safe in elderly patients.
The National Surgical Quality Improvement Program (NSQIP) database was queried, from the years 2005 to 2011, to identify patients who underwent TEVAR. Octogenarians were separated into two groups, one where the LSA was covered (C-SA) and another where it was not covered (U-SA). Patient demographics, comorbidities, perioperative data, and outcomes were compared.
There were a total of 392 patients over age 80 who underwent TEVAR. There were 128 patients in the C-SA group and 264 in the U-SA group. There was no significant difference in demographics or baseline cardiovascular or pulmonary comorbidities between groups. There was also no difference in emergency procedures between C-SA and U-SA groups (27% v. 21%, p=0.18). It was found that the C-SA group had significantly more intra-operative cardiac arrest (4% v. 1%, p=0.03) and significantly more received intra-operative blood transfusions (32% v. 21%, p=0.02). There was also a higher post-operative rate of stroke (9% v. 3%, p=0.03) and sepsis (9% v. 3%, <0.01) in the C-SA group compared to the U-SA group.
Covering the LSA in octogenarians is associated with significantly increased peri-operative morbidity. We recommend caution when considering coverage of the LCA during TEVAR. These patients may benefit from elective revascularization when possible.

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