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. 2018 May;7(3):414-421.
doi: 10.21037/acs.2018.03.14.

Management of the difficult left subclavian artery during aortic arch repair

Ali Hage  1 , Olivia Ginty  1 , Adam Power  2 , Luc Dubois  2 , Francois Dagenais  3 , Jehangir J Appoo  4 , John Bozinovski  5 , Michael W A Chu  1 ; Canadian Thoracic Aortic Collaborative (CTAC) Investigators
Affiliations

Management of the difficult left subclavian artery during aortic arch repair

Ali Hage et al. Ann Cardiothorac Surg. 2018 May.

Abstract

Management of the left subclavian artery (SCA) during aortic arch surgery is associated with several challenges, including preserving distal perfusion, achieving hemostasis and preventing posterior circulation stroke and spinal cord injury. The most common challenge remains its deep position in the chest, often exacerbated by posterior and apical displacement from an arch aneurysm. We discuss several management options consisting of pre-, intra- and post-operative strategies and their respective advantages, disadvantages and clinical outcomes. A clinical algorithm is proposed to help guide decision-making in managing the difficult left SCA during aortic arch repair.

Keywords: Aortic arch surgery; left subclavian artery (SCA); revascularization.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Drawing of a carotid-subclavian transposition with ligation of the proximal subclavian artery.
Figure 2
Figure 2
Drawing of a carotid-subclavian bypass with coil embolization of the proximal subclavian artery.
Figure 3
Figure 3
Drawing of an anatomic reconstruction of the subclavian artery using a Dacron graft between the subclavian artery and the aortic arch graft.
Figure 4
Figure 4
Drawing of an extra-anatomic reconstruction of the subclavian artery bypassed to the left axillary artery.
Figure 5
Figure 5
Drawing of an extra-anatomic reconstruction using a Dacron graft between the aortic arch graft and the distal left subclavian artery.
Figure 6
Figure 6
Drawing of a direct cannulation of the subclavian artery ostium with a hybrid vascular graft.
Figure 7
Figure 7
Approach to the selection of the left SCA revascularization technique. SCA, subclavian artery; LITA, left internal thoracic artery.
See this image and copyright information in PMC

References

    1. Appoo JJ, Bozinovski J, Chu MW, et al. Canadian Cardiovascular Society/Canadian Society of Cardiac Surgeons/Canadian Society for Vascular Surgery joint position statement on open and endovascular surgery for thoracic aortic disease. Can J Cardiol 2016;32:703-13. 10.1016/j.cjca.2015.12.037 - DOI - PubMed
    1. Heinemann MK, Buehner B, Jurmann MJ, et al. Use of the “elephant trunk technique” in aortic surgery. Ann Thorac Surg 1995;60:2-6; discussion 7. 10.1016/S0003-4975(95)00319-3 - DOI - PubMed
    1. Feezor RJ, Lee WA. Management of the left subclavian artery during TEVAR. Semin Vasc Surg 2009;22:159-64. 10.1053/j.semvascsurg.2009.07.007 - DOI - PubMed
    1. Waterford SD, Chou D, Bombien R, et al. Left subclavian arterial coverage and stroke during thoracic aortic endografting: a systematic review. Ann Thorac Surg 2016;101:381-9. 10.1016/j.athoracsur.2015.05.138 - DOI - PubMed
    1. Sobocinski J, Patterson BO, Karthikesalingam A, et al. The effect of left subclavian artery coverage in thoracic endovascular aortic repair. Ann Thorac Surg 2016;101:810-7. 10.1016/j.athoracsur.2015.08.069 - DOI - PubMed

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