Two-Year Patency of the Left Vertebral Artery after Carotid-Subclavian Bypass or Transposition before Thoracic Endovascular Aortic Repair in Zone II.

BACKGROUND

Carotid-subclavian bypass (CSB) and subclavian-carotid transposition (SCT) are the 2 surgical options for revascularization of the left subclavian artery (LSA) prior to coverage during thoracic endovascular aneurysm repair (TEVAR) in zone 2. This helps to prevent spinal cord injury by maintaining blood flow to the spine via the vertebral artery. The aim was to compare CSB with SCT prior to TEVAR regarding vertebral patency and surgical outcomes.

METHODS

Bicentric retrospective comparative study of consecutive patients who underwent CSB or SCT for thoracic aortic disease (dissection, aneurysm, lusoria) from 2017 to 2022.

RESULTS

Eighty-six patients were included: 41 bypasses and 49 transpositions. Median follow-up was 27 and 24.8 months, respectively. Indications for TEVAR were aneurysm (42.2%) and aortic dissection (57.8%). The complication rate was 24.4% for CSB versus 8.2% for SCT, including stroke (2.4 vs. 2%) and spinal cord injury (4.9 vs. 2%). At 2 years, 6 (14.6%) vertebral arteries and 3 (7.3%) grafts occluded in the CSB group, and 2 (4%) vertebral arteries occluded without LSA event among the SCT.

CONCLUSION

In our experience, CSB prior to LSA coverage by TEVAR shows a higher rate of postoperative complications and a nonsignificant higher incidence of vertebral and LSA occlusion as compared to SCT.