Perioperative Outcomes Of Left Subclavian Artery Coverage And Revascularization In Thoracic Endovascular Aortic Repair
Munir Paul Moacdieh, MD, Sina Zarrintan, MD, MS, MPH, Asma Mathlouthi, MD, Isaac Naazie, MD, Andrew Barleben, MD, Mahmoud B. Malas, MD, MHS.
University of California San Diego Health, La Jolla, CA, USA.
Objectives: The aim of this study is to use a large, multi-center database to examine the effects of left subclavian artery (LSA) coverage and revascularization on perioperative outcomes of stroke, arm ischemia (AI), spinal cord ischemia (SCI) and 30-day mortality.
Methods: Patients who had undergone TEVAR for any indication in the VQI TEVAR database between 2011 and 2021 were identified. Patients who had conversion to open repair, proximal disease > zone 5 and distal zone disease < zone 3 were excluded. Outcomes were perioperative stroke, AI, SCI and 30-day mortality.
Results: A total of 12,611 TEVAR patients met our inclusion criteria. There were 4,222 patients with LSA coverage, of which 2,600 underwent revascularization. The results are summarized in Table I. When compared to no coverage, LSA coverage with no revascularization was associated with a significant increase in the risk of stroke (aOR 1.6; 95% CI, 1.1-2.2; P = .010) and AI (aOR 5.4; 95% CI, 2.9-10.2; P < .001), while there was no difference in SCI (aOR 1.2; 95% CI, 0.8-1.8; P = .489) and 30-day mortality (aOR 1.3; 95% CI, 0.98-1.7; P = .066). When compared to no coverage, LSA coverage with revascularization was also associated with a significant increase in the risk of stroke (aOR 1.6; 95% CI, 1.2-2.1; P = .001) and AI (aOR 3.1; 95% CI, 1.4-7.1; P = .007), while SCI (aOR 0.9; 95% CI, 0.6-1.3; P = .592) and 30-day mortality (aOR 1.0; 95% CI, 0.8-1.3; P = .911) were not different. When compared to coverage with no revascularization, LSA coverage with revascularization was associated with a decreased risk of AI (aOR 0.4; 95% CI, 0.2-0.7; P = .003) but no difference in stroke (aOR 0.9; 95% CI, 0.6-1.3; P = .535), SCI (aOR 0.9; 95% CI, 0.6-1.2; P = .410) or 30-day mortality (aOR 0.9; 95% CI, 0.7-1.2; P = .460).
Conclusions: In this large national real-world data, TEVAR with LSA coverage was associated with increased risk of perioperative stroke and arm ischemia regardless of revascularization status. LSA revascularization was beneficial in only reducing the risk of arm ischemia. 
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