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Thoracic endovascular aortic repair (TEVAR) is the favoured approach to treat Type-B aortic dissections (TBAD). In order to obtain an adequate proximal landing zone, the coverage of the left subclavian artery (LSA) is often necessary. Possible neurological complications are still under debate. We investigated the management of LSA in TBAD patients undergoing endovascular repair.We searched in PubMed and MEDLINE databases up to October 2020 for studies on TEVAR in TBAD. Data on study design, demographic, endograft details, LSA coverage and revascularization, mortality, complications, and follow-up were extracted and analyzed. Effects of LSA coverage and revascularization on neurological complications and outcomes were investigated.A total of 26 articles (24 retrospective, 2 prospective) were deemed eligible for the study. In total, 1483 patients (mean age: 56.9±6.2 years) received TEVAR for acute (932; 62.9%), subacute (36; 2.4%) or chronic (515; 34.7%) Type-B dissection, with a success rate of 97.8% and hospital mortality of 4.9%. LSA origin was covered in 707 patients (47.7%) and 326 underwent LSA revascularization (surgical: 96; endovascular: 170; unspecified and not reported: 60). LSA revascularization was concomitant in 68.1% of cases and post TEVAR in 1.8% (not reported: 30.1%). Ten patients (10/1146, 0.9%) suffered from left arm claudication and the overall stroke rate was 3.3% (2.7% in patients with covered LSA; 1% in patients with uncovered LSA, p=0.0815). In patients with stroke and covered LSA, 1% (2/203) had LSA revascularization and 4.8% (5/105) did not (p=0.0478). Twenty-six patients (1.9%) had paraplegia: 0.7% (3/433) had a covered LSA and 1.4% (7/491) uncovered LSA (p=0.3508), not reported in 16 patients. Endoleak was present in 138 patients (13.4%) during a mean follow-up time of 32.1±25.6 months.Left subclavian artery coverage during endovascular repair for complicated Type-B aortic dissection does not significantly increase the risk of neurological complications but its revascularization should be always recommended. |
