The consequences of covering the origin of the left subclavian artery by the coated part of the thoracic stent graft in patients with aneurysm or dissection of the descending aorta

Abstract

Background. The usage of thoracic endografts in the treatment of thoracic aortic lesions is a universally recognized method. Intentional coverage of the left subclavian artery during deployment of the endograft could be associated with several complications such as stroke, spinal cord ischaemia, left arm ischaemia, and vertebrobasilar ischaemia. This study presents the incidence of complications associated with LSA coverage in 60 patients with LSA covered during placement of thoracic endograft. Additionally, the relationship between incidence of complications and factors such as age and type of pathology is analysed.
Material and methods. Sixty patients were qualified to the study, 12 women and 48 men between the ages of 23 and 83 years. The mean age was 56 years. A total of 21 patients were operated on for true aneurysm, 9 for post-traumatic aneurysm, 22 for Stanford B dissection, and 8 for Stanford A dissection. Patients were assessed in terms of presence of stroke, spinal cord ischaemia as well as symptoms associated with left arm ischaemia and vertebrobasilar ischaemia. The incidence of present symptoms was analysed in separate subgroups based on the type of pathology of the aorta due to which patients were operated (true aneurysm, traumatic aneurysm, Stanford type A dissection, and Stanford type B dissection) and age subgroups.
Results. In none of the 60 patients enrolled for the study spinal cord ischaemia was observed. Two cases (3.3%) of reversible stroke (RIND reversible ischaemic neurological deficit) and one case (1.6%) of stroke (complete ischaemic stroke CIS) were observed. Regarding symptoms typical for subclavian steal syndrome, dizziness occurred in 10 patients (16.7%), vertigo in 2 patients (3.3%), left arm weakness in 32 patients (53.2%), and coldness — in 26 patients (43.3%). Neither rest pain nor pain after exercise was observed in any case. Statistical analysis did not show any connection between the incidence of complications and age or type of pathology for which the patient had been operated.
Conclusions. Planned coverage of the LSA is a safe procedure. In most of cases patients with covered LSA did not require any further reconstructions.
Acta Angiol 2011; 17, 4: 251–263