[MÖB-05] Comparative Retrospective Cohort Study of Carotid-Subclavian Bypass vs. In Situ Fenestration For Left Subclavian Artery Revascularization During Zone 2 Thoracic Endovascular Aortic Repair: A Single-Center Experience

Objective: This study aimed to compare the carotid-subclavian bypass with in situ needle fenestration (ISNF) for left subclavian artery (LSA) revascularization and discuss the treatment approach. Methods: All patients who underwent zone 2 thoracic endovascular aortic repair (TEVAR) with ISNF or carotidsubclavian bypass for LSA revascularization at our institution between February 2011 and February 2024 were retrospectively reviewed. Preoperative patient characteristics and primary outcomes, including operative mortality, transient ischemic attack or stroke, and spinal cord ischemia, were analyzed between groups. Results: During the study period, 185 patients underwent TEVAR. Fifty-one of these patients underwent LSA revascularization with zone 2 TEVAR, with 32 of them being carotid-subclavian bypass and 19 of them being ISNF. The technical success rate was %100. There was no statistically significant difference between the groups regarding stroke, transient ischemic attack, spinal cord ischemia, and death (p>0.05). Conclusion: Endovascular techniques, such as ISNF, have emerged as viable alternatives to traditional carotidsubclavian bypass for LSA revascularization in zone 2 TEVAR procedures. Our findings indicate that ISNF is a feasible and effective method, offering similar perioperative outcomes and mortality rates compared to carotid-subclavian bypass. After a precise patient selection process and under experienced hands, ISNF appears to be associated with similar perioperative outcomes and mortality rates with the carotid-subclavian bypass.