Carotid-Axillary Bypass as an Alternative to Carotid-Subclavian Bypass Following Coverage of Left Subclavian Artery During TEVAR

Introduction: Thoracic Endovascular Aortic Repair (TEVAR) has become the procedure of choice for pathology involving the descending thoracic aorta since its approval by the FDA in 2005. Left subclavian artery (LSA) coverage is commonly required to facilitate an adequate proximal landing zone for the...

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Veröffentlicht in:Vascular and endovascular surgery 2021-04, Vol.55 (3), p.265-268
Hauptverfasser: Parker, Michael H., Colpitts, Dayle K., Gilson, Genevieve F., Ryan, Liam, Mukherjee, Dipankar
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container_end_page 268
container_issue 3
container_start_page 265
container_title Vascular and endovascular surgery
container_volume 55
creator Parker, Michael H.
Colpitts, Dayle K.
Gilson, Genevieve F.
Ryan, Liam
Mukherjee, Dipankar
description Introduction: Thoracic Endovascular Aortic Repair (TEVAR) has become the procedure of choice for pathology involving the descending thoracic aorta since its approval by the FDA in 2005. Left subclavian artery (LSA) coverage is commonly required to facilitate an adequate proximal landing zone for the endograft. The traditional revascularization procedure of choice is carotid-subclavian bypass, however recent studies report complication rates as high as 29%—specifically phrenic nerve palsy in 25% of patients undergoing this procedure. Our aim is to present our experience using carotid-axillary bypass as a safe alternative to carotid-subclavian bypass. Methods: All patients undergoing carotid-axillary bypass for TEVAR with LSA coverage between June 2016 and September 2019 at a tertiary medical center were retrospectively identified. Short-term and long-term complications were identified and analyzed including: phrenic nerve, recurrent laryngeal nerve, and axillary nerve injuries, as well as local vascular complications requiring re-intervention. All perioperative chest radiographs were reviewed for new hemidiaphragm elevation to assess for phrenic nerve injuries. Results: 35 patients underwent carotid-axillary bypass in conjunction with TEVAR during this time period. The majority of bypasses were performed concurrently with TEVAR (80.0%, 28/35) utilizing GORE PROPATEN 8 mm externally supported vascular graft (91.4%, 32/35). The complication rate specific to carotid-axillary bypass was 14.3% (5/35). We observed a significantly lower (0%, 0/35, P < 0.01) rate of phrenic nerve palsy for carotid-axillary bypass compared to the previously reported 25% (27/107) for carotid-subclavian bypass. For patients with available follow-up imaging (85.7%, 30/35), there was a 100% patency rate at time intervals ranging from 0-1066 days (IQR = 3-37.8). Conclusion: Carotid-axillary bypass can be performed as a safe alternative to carotid-subclavian bypass for LSA coverage during TEVAR involving a more superficial anatomic course of dissection. Phrenic nerve palsy, a well-described complication of the traditional carotid-subclavian bypass, was not observed in this retrospective series.
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Left subclavian artery (LSA) coverage is commonly required to facilitate an adequate proximal landing zone for the endograft. The traditional revascularization procedure of choice is carotid-subclavian bypass, however recent studies report complication rates as high as 29%—specifically phrenic nerve palsy in 25% of patients undergoing this procedure. Our aim is to present our experience using carotid-axillary bypass as a safe alternative to carotid-subclavian bypass. Methods: All patients undergoing carotid-axillary bypass for TEVAR with LSA coverage between June 2016 and September 2019 at a tertiary medical center were retrospectively identified. Short-term and long-term complications were identified and analyzed including: phrenic nerve, recurrent laryngeal nerve, and axillary nerve injuries, as well as local vascular complications requiring re-intervention. All perioperative chest radiographs were reviewed for new hemidiaphragm elevation to assess for phrenic nerve injuries. Results: 35 patients underwent carotid-axillary bypass in conjunction with TEVAR during this time period. The majority of bypasses were performed concurrently with TEVAR (80.0%, 28/35) utilizing GORE PROPATEN 8 mm externally supported vascular graft (91.4%, 32/35). The complication rate specific to carotid-axillary bypass was 14.3% (5/35). We observed a significantly lower (0%, 0/35, P &lt; 0.01) rate of phrenic nerve palsy for carotid-axillary bypass compared to the previously reported 25% (27/107) for carotid-subclavian bypass. For patients with available follow-up imaging (85.7%, 30/35), there was a 100% patency rate at time intervals ranging from 0-1066 days (IQR = 3-37.8). Conclusion: Carotid-axillary bypass can be performed as a safe alternative to carotid-subclavian bypass for LSA coverage during TEVAR involving a more superficial anatomic course of dissection. Phrenic nerve palsy, a well-described complication of the traditional carotid-subclavian bypass, was not observed in this retrospective series.</description><identifier>ISSN: 1538-5744</identifier><identifier>EISSN: 1938-9116</identifier><identifier>DOI: 10.1177/1538574420983655</identifier><identifier>PMID: 33357042</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Aged ; Aorta, Thoracic - diagnostic imaging ; Aorta, Thoracic - physiopathology ; Aorta, Thoracic - surgery ; Aortic Diseases - diagnostic imaging ; Aortic Diseases - physiopathology ; Aortic Diseases - surgery ; Axillary Artery - diagnostic imaging ; Axillary Artery - physiopathology ; Axillary Artery - surgery ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation - adverse effects ; Blood Vessel Prosthesis Implantation - instrumentation ; Carotid Arteries - diagnostic imaging ; Carotid Arteries - physiopathology ; Carotid Arteries - surgery ; Endovascular Procedures - adverse effects ; Endovascular Procedures - instrumentation ; Female ; Humans ; Male ; Postoperative Complications - etiology ; Postoperative Complications - therapy ; Prosthesis Design ; Retreatment ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Stents ; Subclavian Artery - diagnostic imaging ; Subclavian Artery - physiopathology ; Subclavian Artery - surgery ; Time Factors ; Treatment Outcome ; Vascular Patency</subject><ispartof>Vascular and endovascular surgery, 2021-04, Vol.55 (3), p.265-268</ispartof><rights>The Author(s) 2020</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c337t-4df9cb19b3adb2acf5b9ccac3ad190b96c7266aebf84c8fe5ac854139e6d7a363</citedby><cites>FETCH-LOGICAL-c337t-4df9cb19b3adb2acf5b9ccac3ad190b96c7266aebf84c8fe5ac854139e6d7a363</cites><orcidid>0000-0003-4031-2335</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/1538574420983655$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/1538574420983655$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21817,27922,27923,43619,43620</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33357042$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Parker, Michael H.</creatorcontrib><creatorcontrib>Colpitts, Dayle K.</creatorcontrib><creatorcontrib>Gilson, Genevieve F.</creatorcontrib><creatorcontrib>Ryan, Liam</creatorcontrib><creatorcontrib>Mukherjee, Dipankar</creatorcontrib><title>Carotid-Axillary Bypass as an Alternative to Carotid-Subclavian Bypass Following Coverage of Left Subclavian Artery During TEVAR</title><title>Vascular and endovascular surgery</title><addtitle>Vasc Endovascular Surg</addtitle><description>Introduction: Thoracic Endovascular Aortic Repair (TEVAR) has become the procedure of choice for pathology involving the descending thoracic aorta since its approval by the FDA in 2005. Left subclavian artery (LSA) coverage is commonly required to facilitate an adequate proximal landing zone for the endograft. The traditional revascularization procedure of choice is carotid-subclavian bypass, however recent studies report complication rates as high as 29%—specifically phrenic nerve palsy in 25% of patients undergoing this procedure. Our aim is to present our experience using carotid-axillary bypass as a safe alternative to carotid-subclavian bypass. Methods: All patients undergoing carotid-axillary bypass for TEVAR with LSA coverage between June 2016 and September 2019 at a tertiary medical center were retrospectively identified. Short-term and long-term complications were identified and analyzed including: phrenic nerve, recurrent laryngeal nerve, and axillary nerve injuries, as well as local vascular complications requiring re-intervention. All perioperative chest radiographs were reviewed for new hemidiaphragm elevation to assess for phrenic nerve injuries. Results: 35 patients underwent carotid-axillary bypass in conjunction with TEVAR during this time period. The majority of bypasses were performed concurrently with TEVAR (80.0%, 28/35) utilizing GORE PROPATEN 8 mm externally supported vascular graft (91.4%, 32/35). The complication rate specific to carotid-axillary bypass was 14.3% (5/35). We observed a significantly lower (0%, 0/35, P &lt; 0.01) rate of phrenic nerve palsy for carotid-axillary bypass compared to the previously reported 25% (27/107) for carotid-subclavian bypass. For patients with available follow-up imaging (85.7%, 30/35), there was a 100% patency rate at time intervals ranging from 0-1066 days (IQR = 3-37.8). Conclusion: Carotid-axillary bypass can be performed as a safe alternative to carotid-subclavian bypass for LSA coverage during TEVAR involving a more superficial anatomic course of dissection. Phrenic nerve palsy, a well-described complication of the traditional carotid-subclavian bypass, was not observed in this retrospective series.</description><subject>Aged</subject><subject>Aorta, Thoracic - diagnostic imaging</subject><subject>Aorta, Thoracic - physiopathology</subject><subject>Aorta, Thoracic - surgery</subject><subject>Aortic Diseases - diagnostic imaging</subject><subject>Aortic Diseases - physiopathology</subject><subject>Aortic Diseases - surgery</subject><subject>Axillary Artery - diagnostic imaging</subject><subject>Axillary Artery - physiopathology</subject><subject>Axillary Artery - surgery</subject><subject>Blood Vessel Prosthesis</subject><subject>Blood Vessel Prosthesis Implantation - adverse effects</subject><subject>Blood Vessel Prosthesis Implantation - instrumentation</subject><subject>Carotid Arteries - diagnostic imaging</subject><subject>Carotid Arteries - physiopathology</subject><subject>Carotid Arteries - surgery</subject><subject>Endovascular Procedures - adverse effects</subject><subject>Endovascular Procedures - instrumentation</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - therapy</subject><subject>Prosthesis Design</subject><subject>Retreatment</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Stents</subject><subject>Subclavian Artery - diagnostic imaging</subject><subject>Subclavian Artery - physiopathology</subject><subject>Subclavian Artery - surgery</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Vascular Patency</subject><issn>1538-5744</issn><issn>1938-9116</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kMFLwzAUh4MoTqd3T5Kjl2rSJG1zrHVTYSDo9FqSNBkdXTOTdrqbf7oZ20QE4UFeeN_7wfsAuMDoGuM0vcGMZCylNEY8IwljB-AEc5JFHOPkMPRhHG3mA3Dq_RwhnGGaHYMBIYSliMYn4KsQznZ1FeWfddMIt4a366XwHopQLcybTrtWdPVKw87CPfzSS9WIVR2IHT62TWM_6nYGC7vSTsw0tAZOtOngLzh3IW4N73q3Iaejt_z5DBwZ0Xh9vnuH4HU8mhYP0eTp_rHIJ5EiJO0iWhmuJOaSiErGQhkmuVJChS_mSPJEpXGSCC1NRlVmNBMqYxQTrpMqFSQhQ3C1zV06-95r35WL2isdbm617X0Z05TQGDPEAoq2qHLWe6dNuXT1IrgpMSo33su_3sPK5S69lwtd_SzsRQcg2gI-qCnntg9WG_9_4DeHBYx0</recordid><startdate>202104</startdate><enddate>202104</enddate><creator>Parker, Michael H.</creator><creator>Colpitts, Dayle K.</creator><creator>Gilson, Genevieve F.</creator><creator>Ryan, Liam</creator><creator>Mukherjee, Dipankar</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4031-2335</orcidid></search><sort><creationdate>202104</creationdate><title>Carotid-Axillary Bypass as an Alternative to Carotid-Subclavian Bypass Following Coverage of Left Subclavian Artery During TEVAR</title><author>Parker, Michael H. ; Colpitts, Dayle K. ; Gilson, Genevieve F. ; Ryan, Liam ; Mukherjee, Dipankar</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c337t-4df9cb19b3adb2acf5b9ccac3ad190b96c7266aebf84c8fe5ac854139e6d7a363</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Aorta, Thoracic - diagnostic imaging</topic><topic>Aorta, Thoracic - physiopathology</topic><topic>Aorta, Thoracic - surgery</topic><topic>Aortic Diseases - diagnostic imaging</topic><topic>Aortic Diseases - physiopathology</topic><topic>Aortic Diseases - surgery</topic><topic>Axillary Artery - diagnostic imaging</topic><topic>Axillary Artery - physiopathology</topic><topic>Axillary Artery - surgery</topic><topic>Blood Vessel Prosthesis</topic><topic>Blood Vessel Prosthesis Implantation - adverse effects</topic><topic>Blood Vessel Prosthesis Implantation - instrumentation</topic><topic>Carotid Arteries - diagnostic imaging</topic><topic>Carotid Arteries - physiopathology</topic><topic>Carotid Arteries - surgery</topic><topic>Endovascular Procedures - adverse effects</topic><topic>Endovascular Procedures - instrumentation</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - therapy</topic><topic>Prosthesis Design</topic><topic>Retreatment</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Stents</topic><topic>Subclavian Artery - diagnostic imaging</topic><topic>Subclavian Artery - physiopathology</topic><topic>Subclavian Artery - surgery</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Vascular Patency</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Parker, Michael H.</creatorcontrib><creatorcontrib>Colpitts, Dayle K.</creatorcontrib><creatorcontrib>Gilson, Genevieve F.</creatorcontrib><creatorcontrib>Ryan, Liam</creatorcontrib><creatorcontrib>Mukherjee, Dipankar</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Vascular and endovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Parker, Michael H.</au><au>Colpitts, Dayle K.</au><au>Gilson, Genevieve F.</au><au>Ryan, Liam</au><au>Mukherjee, Dipankar</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Carotid-Axillary Bypass as an Alternative to Carotid-Subclavian Bypass Following Coverage of Left Subclavian Artery During TEVAR</atitle><jtitle>Vascular and endovascular surgery</jtitle><addtitle>Vasc Endovascular Surg</addtitle><date>2021-04</date><risdate>2021</risdate><volume>55</volume><issue>3</issue><spage>265</spage><epage>268</epage><pages>265-268</pages><issn>1538-5744</issn><eissn>1938-9116</eissn><abstract>Introduction: Thoracic Endovascular Aortic Repair (TEVAR) has become the procedure of choice for pathology involving the descending thoracic aorta since its approval by the FDA in 2005. Left subclavian artery (LSA) coverage is commonly required to facilitate an adequate proximal landing zone for the endograft. The traditional revascularization procedure of choice is carotid-subclavian bypass, however recent studies report complication rates as high as 29%—specifically phrenic nerve palsy in 25% of patients undergoing this procedure. Our aim is to present our experience using carotid-axillary bypass as a safe alternative to carotid-subclavian bypass. Methods: All patients undergoing carotid-axillary bypass for TEVAR with LSA coverage between June 2016 and September 2019 at a tertiary medical center were retrospectively identified. Short-term and long-term complications were identified and analyzed including: phrenic nerve, recurrent laryngeal nerve, and axillary nerve injuries, as well as local vascular complications requiring re-intervention. All perioperative chest radiographs were reviewed for new hemidiaphragm elevation to assess for phrenic nerve injuries. Results: 35 patients underwent carotid-axillary bypass in conjunction with TEVAR during this time period. The majority of bypasses were performed concurrently with TEVAR (80.0%, 28/35) utilizing GORE PROPATEN 8 mm externally supported vascular graft (91.4%, 32/35). The complication rate specific to carotid-axillary bypass was 14.3% (5/35). We observed a significantly lower (0%, 0/35, P &lt; 0.01) rate of phrenic nerve palsy for carotid-axillary bypass compared to the previously reported 25% (27/107) for carotid-subclavian bypass. For patients with available follow-up imaging (85.7%, 30/35), there was a 100% patency rate at time intervals ranging from 0-1066 days (IQR = 3-37.8). Conclusion: Carotid-axillary bypass can be performed as a safe alternative to carotid-subclavian bypass for LSA coverage during TEVAR involving a more superficial anatomic course of dissection. Phrenic nerve palsy, a well-described complication of the traditional carotid-subclavian bypass, was not observed in this retrospective series.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>33357042</pmid><doi>10.1177/1538574420983655</doi><tpages>4</tpages><orcidid>https://orcid.org/0000-0003-4031-2335</orcidid></addata></record>
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subjects Aged
Aorta, Thoracic - diagnostic imaging
Aorta, Thoracic - physiopathology
Aorta, Thoracic - surgery
Aortic Diseases - diagnostic imaging
Aortic Diseases - physiopathology
Aortic Diseases - surgery
Axillary Artery - diagnostic imaging
Axillary Artery - physiopathology
Axillary Artery - surgery
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation - adverse effects
Blood Vessel Prosthesis Implantation - instrumentation
Carotid Arteries - diagnostic imaging
Carotid Arteries - physiopathology
Carotid Arteries - surgery
Endovascular Procedures - adverse effects
Endovascular Procedures - instrumentation
Female
Humans
Male
Postoperative Complications - etiology
Postoperative Complications - therapy
Prosthesis Design
Retreatment
Retrospective Studies
Risk Assessment
Risk Factors
Stents
Subclavian Artery - diagnostic imaging
Subclavian Artery - physiopathology
Subclavian Artery - surgery
Time Factors
Treatment Outcome
Vascular Patency
title Carotid-Axillary Bypass as an Alternative to Carotid-Subclavian Bypass Following Coverage of Left Subclavian Artery During TEVAR
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