Minimally invasive management of Stanford B aortic dissection involving the left subclavian artery.

OBJECTIVES: This retrospective exploratory study evaluated outcomes of different management strategies of the left subclavian artery (LSCA) during TEVAR for Stanford type B aortic dissection. METHODS: Thirty-six patients with Stanford type B aortic dissection with involvement of the LSCA were evaluated retrospectively and divided into three groups based on management strategy: direct LSCA coverage, right-to-left subclavian artery bypass (subclavian-subclavian artery bypass), and physician-modified fenestrated TEVAR. The primary outcomes were LSCA-related complications, including stroke, dizziness, and upper limb ischemia. RESULTS: Thirty-six patients underwent TEVAR with an assigned management strategy for the LSCA. Two patients in the direct coverage group had transient dizziness, without experiencing a major embolic stroke or upper limb ischemia. Of the 16 patients undergoing LSCA reconstruction, the fenestrated intervention had a shorter operative time than the bypass (68 vs. 240 min, P = 0.001) and had lower total hospitalization costs (P = 0.001). Two type II endoleaks resolved spontaneously by 1-month follow-up. No 30-day mortality occurred, and 1-year survival was 100%. CONCLUSIONS: While we demonstrated that fenestrated TEVAR had a shorter operative time with reduced hospitalization costs compared to bypass, these findings should be reviewed with caution as a result of the retrospective nature of the study, and relatively small sample size. All patients had an intervention after institutional ethical approval. Multicenter prospective studies are needed to verify these early observations.