Covering/Overstenting of the left subclavian artery in TEVAR intervention to treat various thoracic/thoracoabdominal aortic lesions : Is revascularization of the left arm a must? : (A retrospective real-world cohort study with 12 years of experience and literature review), ( Short title: TEVAR in the daily clinical setting )

Abstract

Pathologies of the thoracic aorta impose themselves as a therapeutic challenge. On one hand, such pathologies must be well secured with the least possible complication; on the other hand, however, the widely varying pathological pictures and likewise anatomical variations of the thoracic aorta are implicated by therapeutic guidelines and recommendations. Hence, the choice of the best therapy is regarded with daily debates in a vascular surgeon’s routine work. This study aims to consider blockage of the left subclavian artery (LSA) as a mandate for the endovascular treatment of the pathologies of the thoracic and suprarenal abdominal aorta - this is not uncommon but scarcely contemplated in the literature- in a unicentric retrospective real-world cohort study. The patient cohort consists of those who underwent endovascular thoracic aortic reconstruction from 2006 to 2018; it contains patients who underwent either pure endovascular or hybrid endovascular/open operative therapy of different thoracic aorta pathologies. Excluded were the patients who suffered from diseases of ascending aorta and infrarenal aortic pathologies. The aim is to prove that the revascularization of LSA - in case of other intact supra-aortic arteries, especially the vertebral arteries, and the continuous circle of Willis without any right-to-left circulatory interruptions - is not necessarily required. The yearly postoperative control of the clinical status and further control-examination of the posterior cerebral/left arm circulation (Doppler-/Duplex-ultrasonography examination, comparative measurement of blood pressure) is sufficient to exclude late postoperative circulatory disturbance of the left arm as well as the cerebral circulation.