Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Typ-2-Diabetes und Adipositas Klimawandel und Gesundheit Neues aus dem Markt Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende Patientenratgeber
Erweiterte Suche
Anmelden
nach oben
European Journal of Trauma and Emergency Surgery
Erschienen in:

17.06.2022 | Review Article

Left subclavian artery coverage during endovascular repair of thoracic aorta injury in trauma and non-trauma patients

verfasst von: Areg Grigorian, Meghan Lewis, Jordan R. Wlodarczyk, Chih Ying Chien, Timothy Park, Demetrios Demetriades

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 6/2022

Einloggen, um Zugang zu erhalten

Abstract

Purpose

In thoracic endovascular aortic repair (TEVAR), the left subclavian artery (LSA) is often occluded. Although most patients tolerate this, some develop ischemic symptoms to the brain or left upper extremity (LUE). A revascularization procedure may be associated with significant complications. The purpose of this review was to assess the incidence of LSA occlusion, resulting ischemic symptoms, and complications related to revascularization operations in trauma patients compared to non-trauma patients.

Methods

Studies from 2010 to 2020 were fully reviewed if they discussed incidence of LSA coverage, LUE ischemia, carotid-subclavian bypass, or complications associated with carotid-subclavian bypass.

Results

Seventeen articles were included in this analysis. A total of 167 patients were identified as trauma cases. Incidence of LSA occlusion in trauma was 91/167 (54%) compared to 281/1446 (19%) in the population exclusive of trauma (p < 0.001). Following LSA occlusion, the rate of LUE claudication/ischemia was 21/56 (38%) for trauma, compared to 12/193 (6%) in non-trauma cases (p < 0.001). The overall complication rate after carotid-subclavian rescue bypass was 29.2% (33/112), with phrenic nerve palsy (24%), recurrent laryngeal nerve palsy (5%), and pseudoaneurysm (1.7%) being the most common.

Conclusion

LSA coverage following TEVAR is common and associated with significant complications, often requiring operative management. The incidence of ischemic complications after occlusion of the LSA is significantly higher in the trauma population. Revascularization procedures to correct the occlusion have a high rate of complications.
Literatur
1.
Teixeira PG, Inaba K, Barmparas G, Georgiou C, Toms C, Noguchi TT, et al. Blunt thoracic aortic injuries: an autopsy study. J Trauma Acute Care Surg. 2011;70(1):197–202.CrossRef
2.
Shackelford S, Nguyen L, Noguchi T, Sathyavagiswaran L, Inaba K, Demetriades D. Fatalities of the 2008 Los Angeles train crash: autopsy findings. Am J Disaster Med. 2011;6(2):127–31.PubMedCrossRef
3.
Hemmila MR, Arbabi S, Rowe SA, Brandt MM, Wang SC, Taheri PA, et al. Delayed repair for blunt thoracic aortic injury: is it really equivalent to early repair? J Trauma. 2004;56(1):13–23.PubMedCrossRef
4.
Fabian TC, Richardson JD, Croce MA, Smith JS, Rodman G, Kearney PA, et al. Prospective study of blunt aortic injury: multicenter trial of the American Association for the Surgery of Trauma. J Trauma Acute Care Surg. 1997;42(3):374–83.CrossRef
5.
Estrera AL, Gochnour DC, Azizzadeh A, Miller CC 3rd, Coogan S, Charlton-Ouw K, et al. Progress in the treatment of blunt thoracic aortic injury: 12-year single-institution experience. Ann Thorac Surg. 2010;90(1):64–71.PubMedCrossRef
6.
Demetriades D, Velmahos GC, Scalea TM, Jurkovich GJ, Karmy-Jones R, Teixeira PG, et al. Operative repair or endovascular stent graft in blunt traumatic thoracic aortic injuries: results of an American Association for the Surgery of Trauma Multicenter Study. J Trauma Acute Care Surg. 2008;64(3):561–71.CrossRef
7.
Grigorian A, Spencer D, Donayre C, Nahmias J, Schubl S, Gabriel V, et al. National trends of thoracic endovascular aortic repair versus open repair in blunt thoracic aortic injury. Ann Vasc Surg. 2018;52:72–8.PubMedCrossRef
8.
McBride CL, Dubose JJ, Miller CC 3rd, Perlick AP, Charlton-Ouw KM, Estrera AL, et al. Intentional left subclavian artery coverage during thoracic endovascular aortic repair for traumatic aortic injury. J Vasc Surg. 2015;61(1):73–9.PubMedCrossRef
9.
DuBose JJ, Leake SS, Brenner M, Pasley J, O’Callaghan T, Luo-Owen X, et al. Contemporary management and outcomes of blunt thoracic aortic injury: a multicenter retrospective study. J Trauma Acute Care Surg. 2015;78(2):360–9.PubMedCrossRef
10.
Murad MH, Rizvi AZ, Malgor R, Carey J, Alkatib AA, Erwin PJ, et al. Comparative effectiveness of the treatments for thoracic aortic transaction. J Vasc Surg. 2011;53(1):193–9.PubMedCrossRef
11.
Lee WA, Matsumura JS, Mitchell RS, Farber MA, Greenberg RK, Azizzadeh A, et al. Endovascular repair of traumatic thoracic aortic injury: clinical practice guidelines of the Society for Vascular Surgery. J Vasc Surg. 2011;53(1):187–92.PubMedCrossRef
12.
Hajibandeh S, Hajibandeh S, Antoniou SA, Torella F, Antoniou GA. Meta-analysis of left subclavian artery coverage with and without revascularization in thoracic endovascular aortic repair. J Endovasc Therapy. 2016;23(4):634–41.CrossRef
13.
Bradshaw RJ, Ahanchi SS, Powell O, Larion S, Brandt C, Soult MC, et al. Left subclavian artery revascularization in zone 2 thoracic endovascular aortic repair is associated with lower stroke risk across all aortic diseases. J Vasc Surg. 2017;65(5):1270–9.PubMedCrossRef
14.
Woo EY, Carpenter JP, Jackson BM, Pochettino A, Bavaria JE, Szeto WY, et al. Left subclavian artery coverage during thoracic endovascular aortic repair: a single-center experience. J Vasc Surg. 2008;48(3):555–60.PubMedCrossRef
15.
Delafontaine JL, Hu B, Tan TW, Tang GL, Starnes BW, Virk C, et al. Outcome comparison of TEVAR with and without left subclavian artery revascularization from analysis of nationwide inpatient sample database. Ann Vasc Surg. 2019;58:174–9.PubMedCrossRef
16.
Antonello M, Menegolo M, Maturi C, Dall’antonia A, Lepidi S, Frigo AC, et al. Intentional coverage of the left subclavian artery during endovascular repair of traumatic descending thoracic aortic transection. J Vasc Surg. 2013;57(3):684-690.e681.PubMedCrossRef
17.
Khoynezhad A, Azizzadeh A, Donayre CE, Matsumoto A, Velazquez O, White R. Results of a multicenter, prospective trial of thoracic endovascular aortic repair for blunt thoracic aortic injury (RESCUE trial). J Vasc Surg. 2013;57(4):899-905.e891.PubMedCrossRef
18.
Teixeira PG, Woo K, Beck AW, Scali ST, Weaver FA. Association of left subclavian artery coverage without revascularization and spinal cord ischemia in patients undergoing thoracic endovascular aortic repair: A Vascular Quality Initiative® analysis. Vascular. 2017;25(6):587–97.PubMedCrossRef
19.
Madenci AL, Ozaki CK, Belkin M, McPhee JT. Carotid-subclavian bypass and subclavian-carotid transposition in the thoracic endovascular aortic repair era. J Vasc Surg. 2013;57(5):1275–82.PubMedCrossRef
20.
Steuer J, Eriksson MO, Nyman R, Björck M, Wanhainen A. Early and long-term outcome after thoracic endovascular aortic repair (TEVAR) for acute complicated type B aortic dissection. Eur J Vasc Endovasc Surg. 2011;41(3):318–23.PubMedCrossRef
21.
Varkevisser RRB, Swerdlow NJ, de Guerre L, Dansey K, Li C, Liang P, et al. Thoracic endovascular aortic repair with left subclavian artery coverage is associated with a high 30-day stroke incidence with or without concomitant revascularization. J Endovasc Therapy. 2020;27(5):769–76.CrossRef
22.
Conway AM, Qato K, Nhan Nguyen Tran N, Giangola G, Carroccio A. Management of the left subclavian artery in TEVAR for chronic type B aortic dissection. Vasc Endovasc Surg. 2020;54(7):586–91.CrossRef
23.
Youssef A, Ghazy T, Kersting S, Leip JL, Hoffmann RT, Kappert U, et al. Management of the left subclavian artery during TEVAR - complications and mid-term follow-up. VASA. 2018;47(5):387–92.PubMedCrossRef
24.
Zamor KC, Eskandari MK, Rodriguez HE, Ho KJ, Morasch MD, Hoel AW. Outcomes of thoracic endovascular aortic repair and subclavian revascularization techniques. J Am Coll Surg. 2015;221(1):93–100.PubMedPubMedCentralCrossRef
25.
Contrella BN, Sabri SS, Tracci MC, Stone JR, Kern JA, Upchurch GR, et al. Outcomes of coverage of the left subclavian artery during endovascular repair of the thoracic aorta. J Vasc Interv Radiol. 2015;26(11):1609–14.PubMedCrossRef
26.
Wojciechowski J, Znaniecki L, Bury K, Rogowski J. Thoracic endovascular aortic repair with left subclavian artery coverage without prophylactic revascularisation-early and midterm results. Langenbecks Arch Surg. 2014;399(5):619–27.PubMedPubMedCentralCrossRef
27.
Patterson BO, Holt PJ, Nienaber C, Fairman RM, Heijmen RH, Thompson MM. Management of the left subclavian artery and neurologic complications after thoracic endovascular aortic repair. J Vasc Surg. 2014;60(6):1491–8.PubMedCrossRef
28.
Maldonado TS, Dexter D, Rockman CB, Veith FJ, Garg K, Arko F, et al. Left subclavian artery coverage during thoracic endovascular aortic aneurysm repair does not mandate revascularization. J Vasc Surg. 2013;57(1):116–24.PubMedCrossRef
29.
Lee TC, Andersen ND, Williams JB, Bhattacharya SD, McCann RL, Hughes GC. Results with a selective revascularization strategy for left subclavian artery coverage during thoracic endovascular aortic repair. Ann Thorac Surg. 2011;92(1):97–103.PubMedPubMedCentralCrossRef
30.
Holt PJ, Johnson C, Hinchliffe RJ, Morgan R, Jahingiri M, Loftus IM, et al. Outcomes of the endovascular management of aortic arch aneurysm: implications for management of the left subclavian artery. J Vasc Surg. 2010;51(6):1329–38.PubMedCrossRef
31.
Campbell I. Chi-squared and Fisher-Irwin tests of two-by-two tables with small sample recommendations. Stat Med. 2007;26(19):3661–75.PubMedCrossRef
32.
33.
34.
Grigorian A, Lekawa M, Dolich M, Schubl SD, Doben AR, Kuza CM, et al. Smoking is associated with an improved short-term outcome in patients with rib fractures. Eur J Trauma Emerg Surg. 2020;46(4):927–33.PubMedCrossRef
35.
Redlinger RE Jr, Ahanchi SS, Panneton JM. In situ laser fenestration during emergent thoracic endovascular aortic repair is an effective method for left subclavian artery revascularization. J Vasc Surg. 2013;58(5):1171–7.PubMedCrossRef
36.
Murphy EH, Dimaio JM, Dean W, Jessen ME, Arko FR. Endovascular repair of acute traumatic thoracic aortic transection with laser-assisted in-situ fenestration of a stent-graft covering the left subclavian artery. J Endovasc Ther. 2009;16(4):457–63.PubMedCrossRef
37.
Li Y, Hu Z, Wang J, Zhang Y, Chen Z, Zhang H. Endovascular chimney technique for aortic arch pathologies treatment: a systematic review and meta-analysis. Ann Vasc Surg. 2018;47:305–15.PubMedCrossRef
38.
Uchida K, Nishimura T, Yamamoto H, Mizobata Y. Efficacy and safety of TEVAR with debranching technique for blunt traumatic aortic injury in patients with severe multiple trauma. Eur J Trauma Emerg Surg. 2019;45(6):959–64.PubMedCrossRef
39.
Voigt SL, Bishawi M, Ranney D, Yerokun B, McCann RL, Hughes GC. Outcomes of carotid-subclavian bypass performed in the setting of thoracic endovascular aortic repair. J Vasc Surg. 2019;69(3):701–9.PubMedCrossRef
40.
Parker MH, Colpitts DK, Gilson GF, Ryan L, Mukherjee D. Carotid-axillary bypass as an alternative to carotid-subclavian bypass following coverage of left subclavian artery during TEVAR. Vasc Endovasc Surg. 2020;55(3):265–8.CrossRef
Metadaten
Titel
Left subclavian artery coverage during endovascular repair of thoracic aorta injury in trauma and non-trauma patients
verfasst von
Areg Grigorian
Meghan Lewis
Jordan R. Wlodarczyk
Chih Ying Chien
Timothy Park
Demetrios Demetriades
Publikationsdatum
17.06.2022
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Trauma and Emergency Surgery / Ausgabe 6/2022
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-022-02027-5

Weitere Artikel der Ausgabe 6/2022

Plasmatic coagulation profile after major traumatic injury: a prospective observational study

  • Open Access
  • Original Article

Bone defect treatment: does the type and properties of the spacer affect the induction of Masquelet membrane? Evidence today

  • Open Access
  • Review Article

Perioperative and oncologic outcomes of interval colectomy performed by acute care surgeons after stenting as a bridge to surgery for left-sided malignant colonic obstruction are non-inferior to the outcomes of colorectal surgeons in the elective setting: single center experience

  • Original Article

Proximal humeral fracture osteosynthesis in Belgium: a retrospective population-based epidemiologic study

  • Original Article

Persistent coagulopathy after gunshot traumatic brain injury: the importance of INR and the SPIN score

  • Original Article

All-terrain vehicle (ATV)-related injuries among different age groups: insights from a 9-year observational study

  • Open Access
  • Original Article

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie erweitert durch Fallbeispiele, Videos und Abbildungen. Zur Fortbildung und Wissenserweiterung, verfasst und geprüft von Expertinnen und Experten der Gesellschaft für Arthroskopie und Gelenkchirurgie (AGA).


Jetzt entdecken!

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Leitlinienkonformes Management thermischer Verletzungen

Thermische Verletzungen gehören zu den schwerwiegendsten Traumen und hinterlassen oft langfristige körperliche und psychische Spuren. Die aktuelle S2k-Leitlinie „Behandlung thermischer Verletzungen im Kindesalter (Verbrennung, Verbrühung)“ bietet eine strukturierte Übersicht über das empfohlene Vorgehen.

Positive Daten für supraskapulären Nervenblock bei Schultersteife

Daten einer aktuellen Metaanalyse sprechen dafür, dass eine Blockade des Nervus suprascapularis bei Schultersteife mit Blick auf Funktion und Schmerzlinderung mindestens so effektiv ist wie eine Physiotherapie oder intraartikulär injizierte Steroide.

Wirbelgleiten: Dem persönlichen Drang zum Versteifen widerstehen!

In einer norwegischen Studie schnitt die alleinige Dekompressions-Op. bei Personen mit Wirbelgleiten auch dann nicht schlechter ab, wenn erfahrene Chirurgen/ Chirurginnen eigentlich für eine zusätzliche Versteifung plädiert hätten.

Nackenschmerzen nach Bandscheibenvorfall: Muskeltraining hilft!

Bei hartnäckigen Schmerzen aufgrund einer zervikalen Radikulopathie schlägt ein Team der Universität Istanbul vor, lokale Steroidinjektionen mit einem speziellen Trainingsprogramm zur Stabilisierung der Nackenmuskulatur zu kombinieren.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise