Outcome of Thoracic Endovascular Aortic Repair with and without Left Subclavian Artery Revascularization

Background: Thoracic endovascular aortic repair (TEVAR) has become the preferred treatment for different thoracic aortic diseases for its safety and minimally invasive nature. In some cases, secure graft fixation requires coverage of the left subclavian artery, which may increase the risk of spinal cord ischemia, stroke and upper limb ischemia but prophylactic left subclavian artery (LSA) revascularization may reduce these complications. Methods: The study aimed to determine whether LSA revascularization reduces the risk of major neurologic or ischemic complications defined as any ischemic stroke, spinal cord ischemia, or ipsilateral upper-limb ischemia requiring intervention within 30 days after zone-2 thoracic endovascular aortic repair (TEVAR). To address this, we analyzed a retrospectively assembled observational cohort derived from prospectively collected data on adults (≥18 years) who underwent zone-2 TEVAR with either LSA revascularization or deliberate LSA coverage without revascularization across three vascular surgery centers: Mansoura University Hospital, and Egypt Healthcare Hospitals in Portsaid and Ismailia. The study period extended from January 2022 to January 2025, enabling comprehensive capture of contemporary management practices and early postoperative outcomes. Results: A significant difference was observed between the LSA revascularization and non-LSA groups only in the use of spinal drains, which were required in 5 patients (85.7%) in the non-LSA group (P<0.05). No significant differences were found between the groups regarding mortality, stroke/TIA, contrast-induced nephropathy, ICU stay, or total hospital stay (P>0.05), indicating comparable perioperative outcomes overall. Conclusion: LSA revascularization during zone-2 TEVAR appeared to be a safe and effective strategy, demonstrating similar rates of major adverse events including death, cerebrovascular complications and renal impairment when compared to non-revascularized patients. These findings support the role of LSA revascularization as a protective measure without increasing perioperative risk