Abstract
Background:
This meta-analysis aimed to compare postoperative outcomes between endovascular and surgical revascularization of the left subclavian artery (LSA) in patients undergoing thoracic endovascular aortic repair (TEVAR).
Methods:
We performed a comprehensive search of the MEDLINE and EMBASE databases through February 2024. Pooled results were calculated, and subgroup analyses focused on the chimney technique for LSA revascularization. Kaplan–Meier curves for mid-term all-cause mortality were reconstructed by extracting time-to-event data from the included studies.
Results:
Twelve nonrandomized studies, including a total of 4158 patients, were analyzed. Procedural duration was significantly longer in the surgical revascularization cohort (p < 0.01). No statistically significant differences were found in other short-term outcomes between the 2 groups. However, subgroup analysis of studies focusing on the chimney technique showed that surgical revascularization was associated with a significantly lower rate of postoperative endoleak [odds ratio; OR (95% confidence interval; CI) = 0.17 (0.06–0.49), p < 0.01]. For mid-term outcomes, there were no significant differences in mortality [hazards ratio; HR (95% CI) = 1.25 (0.71–2.22), p = 0.44], aortic re-intervention rate [HR (95% CI) = 1.10 (0.49–2.47), p = 0.81], or LSA patency rate [HR (95% CI) = 1.24 (0.40–3.89), p = 0.71] between the 2 strategies. The follow-up endoleak rate tended to be lower in the surgical revascularization group [HR (95% CI) = 0.50 (0.24–1.03), p = 0.06], with a more pronounced trend in the subgroup analysis of studies exclusively employing the chimney technique [HR (95% CI) = 0.33 (0.10–1.02), p = 0.05], though the differences were not statistically significant. Reconstructed Kaplan–Meier curves for all-cause mortality indicated no significant difference in mid-term survival between the groups [HR (95% CI) = 0.94 (0.74–1.19), p = 0.60].
Conclusions:
This meta-analysis reveals comparable postoperative outcomes between surgical and endovascular LSA revascularization in patients undergoing TEVAR. However, the chimney technique was associated with a higher rate of postoperative endoleak.
Clinical Impact
This meta-analysis provides insights into the comparative effectiveness of surgical versus endovascular left subclavian artery (LSA) revascularization during thoracic endovascular aortic repair (TEVAR). While both techniques demonstrated comparable short- and mid-term outcomes, the chimney stent-graft technique showed a higher incidence of postoperative endoleak, suggesting a need for careful patient selection and follow-up. These findings will guide clinicians in optimizing LSA revascularization strategies and balancing procedural risks with postoperative outcomes in patients requiring LSA coverage during TEVAR.
Get full access to this article
View all access options for this article.
References
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
