Intentional Left Subclavian Artery Occlusion by Thoracic Aortic Stent-Grafts without Surgical Transposition

Abstract

Purpose:

To report the consequences of endoluminal deployment of stent-grafts in the thoracic aorta with intentional occlusion of the left subclavian artery.

Case Reports:

Three patients with an aortic type-B dissection and 1 with a thoracic aneurysm were treated endoluminally with Talent stent-grafts implanted over the ostium of the left subclavian artery without prior surgical subclavian-carotid transposition. The primary intimal tears were sealed and the degenerative aneurysm excluded; blood pressure in the left arm was significantly diminished immediately after the stent-graft was released, but adequate collateral retrograde perfusion via the left vertebral artery was apparent in all patients. No neurological deficit and no symptoms of left arm ischemia were observed in a follow-up that ranged from 14 to 20 months.

Conclusions:

Our limited experience shows that occlusion of the left subclavian artery with a stent-graft is well tolerated. If ischemic symptoms occur, a transposition procedure can be performed on an elective basis.

Keywords

aortic dissection thoracic aortic aneurysm Talent endograft left vertebral artery collateral flow

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