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Intentional Left Subclavian Artery Coverage During Thoracic Endovascular Aortic Repair (TEVAR) for Traumatic Aortic Injury: A Quality of Life Study
Cameron L McBride1, Joseph J Dubose1, Charles C. Miller, III1, Alexa P. Perlick2, Kristofer M Charlton-Ouw1, Anthony L Estrera1, Hazim J Safi1, Ali Azizzadeh1
1University of Texas Medical School Houston and Memorial Hermann Heart and Vascular Institute, Houston, TX;2University of Texas Health Science Center, Houston, TX

Background: Thoracic endovascular aortic repair (TEVAR) is widely used for treatment of traumatic aortic injury (TAI). Stent graft coverage of the left subclavian artery (LSA) may be required in up to 40% of cases. We evaluated the long-term effects of intentional LSA coverage on symptoms and return to normal activity in TAI patients, compared to a similarly treated group without LSA coverage.
Methods: Patients were identified from a prospective institutional trauma registry between September 2005 and July 2012. TAI was confirmed using computed tomographic angiography (CTA). The electronic medical records, angiograms, and CTAs were reviewed in a retrospective fashion. Personal or telephone interviews were conducted using the SF-12v2® to assess quality of life. An additional questionnaire was used to assess specific LSA symptoms and the ability to return to normal activities. Data were analyzed by spearman rank correlation and multiple linear and logistic regression analysis with appropriate transformations (SAS software).
Results: During the study period, 82 patients (57 male, mean age 49.5 +/- 20 years, mean ISS 34 +/- 10.0) underwent TEVAR for treatment of TAI. Among them, 32 (39.5%) required left subclavian artery coverage (LSAC), while 50 had their LSA uncovered (LSAU). We found no statistically significant difference in SF-12® physical health scores (ρ = -.08, P = .62) between LSAC and LSAU patients. LSAC patients had slightly better mental health scores (ρ = .62, P = .037) than LSAU. LSAC patients did not have increased likelihood of experiencing pain (ρ = -.0056, P = .97), numbness (ρ = -.12, P = .45), parasthesia (ρ = -.11, P = .48), fatigue (ρ = -.066, P = .69), or cramping (ρ = -.12, P = .45). We found no difference in ability to return to activities between groups. The mean follow up time was 3.35 years. Five (16%) of the LSAC patients expired during the follow up period due to unrelated causes.
Conclusions: Intentional coverage of the LSA during TEVAR for TAI appears safe without compromising mental or physical health outcomes. Furthermore, LSAC does not increase the long-term risk of upper extremity symptoms or impairment of normal activities.


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