Coil-in-Plug Method for Left Subclavian Artery Embolization in Thoracic Endovascular Aortic Repair with Arch Vessel Debranching

DOI Web Site 参考文献19件
  • Fujioka Shunichiro
    Department of Cardiovascular Surgery, Kitasato University School of Medicine
  • Kitamura Tadashi
    Department of Cardiovascular Surgery, Kitasato University School of Medicine
  • Mishima Toshiaki
    Department of Cardiovascular Surgery, Kitasato University School of Medicine
  • Mori Hisaya
    Department of Cardiovascular Surgery, Kitasato University School of Medicine
  • Fukuzumi Masaomi
    Department of Cardiovascular Surgery, Kitasato University School of Medicine
  • Shikata Fumiaki
    Department of Cardiovascular Surgery, Kitasato University School of Medicine
  • Miyaji Kagami
    Department of Cardiovascular Surgery, Kitasato University School of Medicine

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<p>Objectives: Since 2018, we have routinely placed an Amplatzer vascular plug (AVP) in the proximal left subclavian artery (LSCA) to prevent embolic events during thoracic endovascular aortic repair with arch vessel debranching (d-TEVAR). Type II endoleaks of LSCA origin were observed in two patients (20%), and the coil-in-plug (CIP) method, i.e., microcatheter insertion through the plug and addition of coil embolization, which has been used since August 2019, was performed. This study aims to evaluate the effectiveness of the CIP method for LSCA embolization.</p><p>Methods: A total of 26 patients who underwent d-TEVAR for an aortic arch aneurysm between 2018 and 2022 were retrospectively reviewed. Ten patients who underwent d-TEVAR with a simple AVP placement (the control group) and 16 patients who underwent d-TEVAR with the CIP method (the CIP group) were compared.</p><p>Results: Two patients had type II endoleaks in the control group, whereas none had them in the CIP group. LSCA length was significantly shorter in patients with endoleaks than in those without endoleaks (24.5 vs. 50.3 mm; p<0.01). No perioperative deaths or cerebral infarctions occurred in either group.</p><p>Conclusions: AVP placement in the LSCA during d-TEVAR effectively prevented perioperative cerebral infarction. d-TEVAR with CIP was especially useful in patients with a short LSCA.</p>

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