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European Journal of Trauma and Emergency Surgery

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17-06-2022 | Review Article

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

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

Published in: European Journal of Trauma and Emergency Surgery | Issue 6/2022

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.

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Title: Left subclavian artery coverage during endovascular repair of thoracic aorta injury in trauma and non-trauma patients
Authors: Areg Grigorian
Meghan Lewis
Jordan R. Wlodarczyk
Chih Ying Chien
Timothy Park
Demetrios Demetriades
Publication date: 17-06-2022
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Trauma and Emergency Surgery / Issue 6/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-022-02027-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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