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Management of an isolated left vertebral artery on the arch during zone 2-landing thoracic endovascular aortic repair: A multicentre retrospective study

  • Author Footnotes
    1 These authors contributed equally to this work;
    Heng Zhang
    Footnotes
    1 These authors contributed equally to this work;
    Affiliations
    Department of Vascular Surgery, the Affiliated Hospital of Qingdao University, Qingdao University, Shandong, China
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  • Author Footnotes
    1 These authors contributed equally to this work;
    Jiaxuan Feng
    Footnotes
    1 These authors contributed equally to this work;
    Affiliations
    Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
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  • Author Footnotes
    1 These authors contributed equally to this work;
    Mingjin Guo
    Footnotes
    1 These authors contributed equally to this work;
    Affiliations
    Department of Vascular Surgery, the Affiliated Hospital of Qingdao University, Qingdao University, Shandong, China
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  • Author Footnotes
    1 These authors contributed equally to this work;
    Junjun Liu
    Footnotes
    1 These authors contributed equally to this work;
    Affiliations
    Department of Vascular Surgery, the Affiliated Hospital of Qingdao University, Qingdao University, Shandong, China
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  • Ding Xu
    Affiliations
    Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
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  • Ye Lu
    Affiliations
    Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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  • Hongqiao Zhu
    Affiliations
    Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
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  • Mingyuan Liu
    Affiliations
    Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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  • Rui Feng
    Correspondence
    Corresponding authors:: Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, 201406.
    Affiliations
    Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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  • Author Footnotes
    1 These authors contributed equally to this work;
Published:November 04, 2022DOI:https://doi.org/10.1016/j.ejvs.2022.11.007
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      Abstract

      Objective

      To compare the early and mid-term outcomes of three different strategies for an isolated left vertebral artery on the arch (LVoA) revascularization during thoracic endovascular aortic repair (TEVAR) with a proximal zone 2 landing.

      Methods

      Between January 2016 and December 2021, 67 patients with LVoA and aortic arch pathologies who underwent zone 2-landing TEVAR at four medical centres were enrolled. These patients were divided into three groups for comparison: the novel chimney (group A, n = 28) with the right brachial-left brachial through-and-through (RLT) procedure, in-vitro fenestration (group B, n = 24), and transposition (group C, n = 15). The flow direction and velocity of LVoA was examined by the Doppler ultrasound in the pre-, intra-, and post-operation period. Primary outcomes were all-cause mortality and neurologic new symptoms.

      Results

      No deaths or neurologic new symptoms occurred within 30 days. The early type Ia endoleak rates were 17.9% (5/28), 16.7% (4/24), and 0.0% (0/15) in groups A, B, and C, respectively (p = .22). All patients had anterograde flow of the LVoA. The mean follow-up time was 63.6 ± 4.0 months. No mortality was observed during follow up. The neurologic new symptoms rates were 0.0%, 8.3%, and 33.3%, respectively. The mid-term type Ia endoleak rates were 7.1%, 12.5%, and 0.0% (p = .35). The bidirectional flow rates in the LVoA were 0.0%, 20.8%, and 26.7% (p = .02). Two cases (8.3%) and three (20.0%) in groups B and C underwent a secondary procedure because of mild-dizziness, but this was not necessary in group A (p = .06).

      Conclusion

      The novel chimney technique of the RLT procedure may be feasible for patients with an LVoA requiring zone 2 anchoring. Accurate determination of the safety and feasibility of this novel technique requires larger samples size and longer follow-up time.

      Keywords

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