| Is it safe to cover the left subclavian artery when placing an endovascular stent in the descending thoracic aorta? | |
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MedLine Citation:
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PMID: 18467426 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the left subclavian artery may be safely covered with a descending thoracic aortic stent without a prior carotid-subclavian artery bypass or transposition procedure. Altogether 2612 abstracts were identified. Forty-five non-randomized control trials and 213 non-controlled papers were found using the reported search and all these were read in full to search for coverage of the left subclavian artery. From these papers, 20 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We identified 20 studies with more than 10 cases of left subclavian artery coverage without prior revascularisation. Aggregating the data from all these studies we found 498 covered left subclavian arteries. Complications included 13 strokes (2.6%), 8 cases of paraplegia or paraparesis (1.6%) and 6 endoleaks due to subclavian backflow (1.2%). Of note there were 51 cases of ischaemia or other symptoms attributable to poor blood flow (10%), which resulted in 20 post-procedural revascularisations (4%). In three studies the mean pressure drop in the left arm was between 36 and 48 mmHg after left subclavian occlusion. We conclude that coverage of the left subclavian artery has a low, but not insignificant, incidence of side-effects. This incidence must be balanced with the urgency of the procedure and may be acceptable in emergency or salvage situations. However, in non-emergency cases we recommend that the carotid arteries, the vertebral arteries and the Circle of Willis are fully assessed by tests such as duplex ultrasound, angiography, CT or MRI scanning. An absent right vertebral artery, diseased carotid arteries or an incomplete Circle of Willis is a contraindication to left subclavian artery coverage without prior transposition or bypass grafting of the left subclavian artery. |
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Authors:
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Joel Dunning; Janet E Martin; Hani Shennib; Davy C Cheng |
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Publication Detail:
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Type: Journal Article Date: 2008-05-08 |
Journal Detail:
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Title: Interactive cardiovascular and thoracic surgery Volume: 7 ISSN: 1569-9285 ISO Abbreviation: Interact Cardiovasc Thorac Surg Publication Date: 2008 Aug |
Date Detail:
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Created Date: 2008-07-30 Completed Date: 2008-10-09 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101158399 Medline TA: Interact Cardiovasc Thorac Surg Country: England |
Other Details:
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Languages: eng Pagination: 690-7 Citation Subset: IM |
Affiliation:
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Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK. joeldunning@doctors.org.uk |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aorta, Thoracic / pathology, surgery* Aortic Diseases / pathology, surgery* Benchmarking Blood Vessel Prosthesis* Blood Vessel Prosthesis Implantation* / adverse effects, instrumentation, methods Evidence-Based Medicine Female Humans Male Patient Selection Risk Assessment Stents* Subclavian Artery / pathology, surgery* Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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