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.
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
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).
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.