Comparing endovascular techniques for left subclavian artery revascularization during zone 2 thoracic endovascular aortic repair for type B acute aortic syndromes: a retrospective cohort study.

Background: Castor-branched stent-graft, chimney stent, and fenestration techniques have been employed for left subclavian artery (LSA) revascularization during zone 2 thoracic endovascular aortic repair (TEVAR), but not recommended routinely. This study aimed to compare the safety and efficacy of these techniques.

Methods: From February 2017 to June 2020, 133 patients with type B acute aortic syndromes undergoing LSA revascularization during zone 2 TEVAR were retrospectively enrolled. The primary outcomes include technical success, mortality, stroke and spinal cord ischemia. The secondary outcomes include aortic remodeling, LSA patency, freedom from aorta-related reintervention.

Results: Fifty patients were treated with the Castor-branched stent-graft (Group A), 42 with the chimney technique (Group B), and 41 with the fenestration technique (Group C). The groups demonstrated a similar technical success rate, with 96% in Group A, 97.62% in Group B, and 95.12% in Group C. Despite a more predominant bird-beak configuration in group A (p = 0.003), no significant difference was observed in perioperative complications. Two TEVAR-related deaths occurred in Groups B and C, while none was reported in Group A. During the first two years of follow-up, favorable aortic remodeling was confirmed in all groups. Each group exhibited two cases of LSA occlusions. Aorta-related reintervention and mortality did not significantly differ among the groups.

Conclusion: Endovascular techniques are feasible for LSA revascularization during zone 2 TEVAR, with favorable aortic remodeling. However, the durability of these procedures requires careful evaluation, given the potential concern of LSA occlusion.