Application of Left Common Carotid-Left Subclavian Artery Shunt for Reconstruction of Left Subclavian Artery in TEVAR of Type B Aortic Dissection with Insufficient Proximal Anchoring Area: 10 Years of Single-Center Experience

Abstract Objectives：In thoracic endovascular aortic repair(TEVAR) of type B aortic dissection (TBAD) , left common carotid-left subclavian artery（LCCA-LSA) shunt is a feasible method to reconstruct left subclavian artery (LSA) in order to provide enough proximal anchoring area. The purpose of this study was to evaluate the safety and early efficacy of LCCA-LSA shunt in the reconstruction of LSA in TEVAR of TBAD with insufficient proximal anchoring area. Methods：The clinical data of 63 patients (mean age 52.3 ±11.6years, 54 males and 9 females) with TBAD who underwent LCCA-LSA shunt to reconstruct LSA in TEVAR from January 2010 to December 2021 were analyzed retrospectively. The technical success rate, operation time, complications such as leakage, stroke, hemorrhage, spinal cord ischemia, pulmonary infection, perioperative death and readmission were recorded and analyzed retrospectively. Results：A total of 63 patients were included, 60 cases (95.2%) of LCCA-LSA shunt, 3 cases (4.8%) of LSA-LCCA transposition; 10 cases (15.9%) underwent carotid-carotid bypass surgery at the same time, 9 cases (14.3%) underwent ligating LSA of proximal LVA surgery and 15 cases (23.8%) underwent embolization of LSA root surgery. The average operation time is 323.7±91.6 min. The results of intraoperative angiography showed that all the LSA were reserved, therefore the technical success rate was 100%. Within 1 month after operation, 11 cases (17.5%) had complications occurred, 9 cases(14.3%) were cured and discharged from hospital, 1 case (1.6%) had sequela of cerebral infarction and 1 case (1.6%) died at 18 days after the surgery. During the follow-up period, 6 patients (9.5%) were readmitted to hospital because of new distal rupture or/and internal leakage, all of which were cured and discharged. Conclusion：For TBAD patients without enough proximal anchoring area, LCCA-LSA shunt for LSA reconstruction has a high technical success rate, low mortality and low incidence of residual complications, which is a good choice and has unique advantages. However, medium and longterm safety and efficacy still need a large number of sample studies.