Oclusión intencional de la arteria subclavia izquierda durante el tratamiento endovascular de la aorta torácica descendente;
Intentional Occlusion of the Left Subclavian Artery during Endovascular Repair of Descending Thoracic Aorta

IntroducciónLa seguridad y la eficacia del tratamiento endovascular de la aorta torácica descendente dependen de ciertas condiciones anatómicas y en particular de la presencia de un segmento sano de aorta (cuello proximal). En una proporción importante de pacientes, este cuello proximal es insuficiente o inexistente. Un ObjetivoEvaluar las consecuencias clínicas y neurológicas de la oclusión intencional de la arteria subclavia izquierda durante el tratamiento endovascular de la aorta torácica descendente.Material y métodosEntre agosto de 1999 y febrero de 2010, 136 pacientes fueron tratados consecutivamente con implante de endoprótesis autoexpandibles. En 29 pacientes (21%) con ausencia de un cuello proximal adecuado (sector sano de aorta ≥ 15 mm de longitud) se debió cubrir intencionalmente el origen de la arteria subclavia izquierda. (resumen completo en pdf) 

SUMMARYThe safety and efficacy of endovascular repair of descending thoracic aorta depends on certain anatomical conditions, in particular the presence of a healthy segment of the aorta (proximal neck). In a significant proportion of patients, the proximal neck is inadequate or non-existent. A bypass or transposition of the left subclavian artery would maintain an adequate perfusion of the left arm after stent-graft implantation. However, this surgical approach is not always feasible in unstable patients who are treated urgently or that have multiple comorbidities.ObjectiveEvaluate the clinical and neurological consequences of intentional occlusion of the left subclavian artery during endovascular repair of descending thoracic aorta.Material and MethodsBetween August 1999 and February 2010, 136 patients were consecutively treated with implantation of self-expandable stent-grafts. In 29 patients (21%) with absence of an adequate proximal neck (healthy aorta sector ≥ 15mm in length), it had to be intentionally covered the origin of the left subclavian artery. In all cases, before procedure it was carried out a selective angiography of the right vertebral artery in order to confirm the permeability of this and the conformation of the vertebrobasilar circulation.   Background