Long-Term Outcomes and Patency of Left Carotid-Subclavian Bypass in Thoracic Endovascular Aortic Repair

OBJECTIVES: Left carotid-subclavian bypass (LCSB) is a classic strategy for left subclavian artery (LSA) revascularization in thoracic endovascular aortic repair (TEVAR) patients. Its employment has been reduced in recent years due to the advent of endovascular solutions for LSA management. Data on outcomes of LCSB are lacking, especially for graft-related complications and patency at follow-up. METHODS: All patients who underwent TEVAR with LCSB from November 2005 to January 2025, in an elective or urgent setting, were retrospectively analysed in terms of pre- and intraoperative characteristics, short- and mid-term outcomes. In-hospital outcomes were compared between the urgent and elective groups. LCSB patency at follow-up imaging was reported. A Kaplan-Meier analysis was performed on survival, freedom from reintervention and LCSB patency. RESULTS: LCSB was performed in 161 patients, 36 of which (22.3%) were urgent procedures. In-hospital mortality was 3.7%, with no significant difference between the elective and the urgent group (3.2% vs 5.6% respectively, P = .491). There was a not statistically significantly higher incidence of stroke in the urgent patients (0.8% vs 5.6%, P = .057). LCSB-related complications occurred in 12 patients (7.4%). Overall LCSB patency at last available follow-up was 97.4%. LSA embolization was necessary in 7 cases (4.5%) due to type II endoleak. At 5 years, survival was 87.4%, freedom from reintervention was 88.5% and LCSB patency was 99%. CONCLUSIONS: LCSB is safe and effective as a LSA revascularization strategy. Even in urgent patients, LCSB was not linked to worse in-hospital outcomes.