Frontiers in Cardiovascular Medicine (Sep 2022)
Comparison of techniques for left subclavian artery preservation during thoracic endovascular aortic repair: A systematic review and single-arm meta-analysis of both endovascular and surgical revascularization
- Yuchong Zhang,
- Yuchong Zhang,
- Yuchong Zhang,
- Yuchong Zhang,
- Yuchong Zhang,
- Xinsheng Xie,
- Ye Yuan,
- Ye Yuan,
- Ye Yuan,
- Ye Yuan,
- Ye Yuan,
- Chengkai Hu,
- Chengkai Hu,
- Chengkai Hu,
- Chengkai Hu,
- Chengkai Hu,
- Enci Wang,
- Enci Wang,
- Enci Wang,
- Enci Wang,
- Enci Wang,
- Yufei Zhao,
- Yufei Zhao,
- Yufei Zhao,
- Yufei Zhao,
- Yufei Zhao,
- Peng Lin,
- Peng Lin,
- Peng Lin,
- Peng Lin,
- Peng Lin,
- Zheyun Li,
- Zheyun Li,
- Zheyun Li,
- Zheyun Li,
- Zheyun Li,
- Fandi Mo,
- Fandi Mo,
- Fandi Mo,
- Fandi Mo,
- Fandi Mo,
- Weiguo Fu,
- Weiguo Fu,
- Weiguo Fu,
- Weiguo Fu,
- Weiguo Fu,
- Lixin Wang,
- Lixin Wang,
- Lixin Wang,
- Lixin Wang,
- Lixin Wang
Affiliations
- Yuchong Zhang
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Xiamen, China
- Yuchong Zhang
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Yuchong Zhang
- Vascular Surgery Institute of Fudan University, Shanghai, China
- Yuchong Zhang
- National Clinical Research Center for Interventional Medicine, Shanghai, China
- Yuchong Zhang
- Fudan Zhangjiang Institute, Shanghai, China
- Xinsheng Xie
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Xiamen, China
- Ye Yuan
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Xiamen, China
- Ye Yuan
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Ye Yuan
- Vascular Surgery Institute of Fudan University, Shanghai, China
- Ye Yuan
- National Clinical Research Center for Interventional Medicine, Shanghai, China
- Ye Yuan
- Fudan Zhangjiang Institute, Shanghai, China
- Chengkai Hu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Xiamen, China
- Chengkai Hu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Chengkai Hu
- Vascular Surgery Institute of Fudan University, Shanghai, China
- Chengkai Hu
- National Clinical Research Center for Interventional Medicine, Shanghai, China
- Chengkai Hu
- Fudan Zhangjiang Institute, Shanghai, China
- Enci Wang
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Xiamen, China
- Enci Wang
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Enci Wang
- Vascular Surgery Institute of Fudan University, Shanghai, China
- Enci Wang
- National Clinical Research Center for Interventional Medicine, Shanghai, China
- Enci Wang
- Fudan Zhangjiang Institute, Shanghai, China
- Yufei Zhao
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Xiamen, China
- Yufei Zhao
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Yufei Zhao
- Vascular Surgery Institute of Fudan University, Shanghai, China
- Yufei Zhao
- National Clinical Research Center for Interventional Medicine, Shanghai, China
- Yufei Zhao
- Fudan Zhangjiang Institute, Shanghai, China
- Peng Lin
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Xiamen, China
- Peng Lin
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Peng Lin
- Vascular Surgery Institute of Fudan University, Shanghai, China
- Peng Lin
- National Clinical Research Center for Interventional Medicine, Shanghai, China
- Peng Lin
- Fudan Zhangjiang Institute, Shanghai, China
- Zheyun Li
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Xiamen, China
- Zheyun Li
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Zheyun Li
- Vascular Surgery Institute of Fudan University, Shanghai, China
- Zheyun Li
- National Clinical Research Center for Interventional Medicine, Shanghai, China
- Zheyun Li
- Fudan Zhangjiang Institute, Shanghai, China
- Fandi Mo
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Xiamen, China
- Fandi Mo
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Fandi Mo
- Vascular Surgery Institute of Fudan University, Shanghai, China
- Fandi Mo
- National Clinical Research Center for Interventional Medicine, Shanghai, China
- Fandi Mo
- Fudan Zhangjiang Institute, Shanghai, China
- Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Xiamen, China
- Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Weiguo Fu
- Vascular Surgery Institute of Fudan University, Shanghai, China
- Weiguo Fu
- National Clinical Research Center for Interventional Medicine, Shanghai, China
- Weiguo Fu
- Fudan Zhangjiang Institute, Shanghai, China
- Lixin Wang
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Xiamen, China
- Lixin Wang
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Lixin Wang
- Vascular Surgery Institute of Fudan University, Shanghai, China
- Lixin Wang
- National Clinical Research Center for Interventional Medicine, Shanghai, China
- Lixin Wang
- Fudan Zhangjiang Institute, Shanghai, China
- DOI
- https://doi.org/10.3389/fcvm.2022.991937
- Journal volume & issue
-
Vol. 9
Abstract
BackgroundCurrently, the optimal technique to revascularize the left subclavian artery (LSA) during thoracic endovascular aortic repair (TEVAR) remains controversial. Our study seeks to characterize early and late clinical results and to assess the advantages and disadvantages of endovascular vs. surgical strategies for the preservation of LSA.MethodsPubMed, Embase and Cochrane Library searches were conducted under the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analyses) standards. Only literature published after January 1994 was included. Studies reporting on endovascular revascularization (ER), surgical revascularization (SR) for LSA preservation were included. 30-day mortality and morbidity rates, restenosis rates, and rates of early and late reintervention are measured as outcomes.ResultsA total of 28 studies involving 2,759 patients were reviewed. All articles were retrospective in design. Single-arm analysis found no significant statistical differences in ER vs. SR in terms of 30-day mortality and perioperative complication rates. The mean follow-up time for the ER cohort was 12.9 months and for the SR cohort was 26.6 months, respectively. Subgroup analysis revealed a higher risk of perioperative stroke (4.2%) and endoleaks (14.2%) with the chimney technique compared to the fenestrated and single-branched stent approaches. Analysis of the double-arm studies did not yield statistically significant results.ConclusionBoth ER and SR are safe and feasible in the preservation of LSA while achieving an adequate proximal landing zone. Among ER strategies, the chimney technique may presents a greater risk of neurological complications and endoleaks, while the single-branched stent grafts demonstrate the lowest complication rate, and the fenestration method for revascularization lies in an intermediate position. Given that the data quality of the included studies were relatively not satisfactory, more randomized controlled trials (RCTs) are needed to provide convincing evidence for optimal approaches to LSA revascularization in the future.
Keywords
