The effect of left subclavian artery coverage on morbidity and mortality in patients undergoing endovascular thoracic aortic interventions: a systematic review and meta-analysis

摘要: Objectives Thoracic endografts (stent grafts) have emerged as a less invasive modality to treat various thoracic aortic lesions. The intentional coverage of the left subclavian artery (LSA) during placement these is associated with several complications including stroke, spinal cord ischemia, and arm ischemia. In this review, we synthesize available evidence regarding LSA coverage. Methods We searched electronic databases (MEDLINE EMBASE) from January 1990 through February 2008 for studies that included patients who received had Eligible control group either endograft without or primary revascularization prior Two independent reviewers determined trial eligibility extracted descriptive, methodological outcome data each eligible study. Meta-analyses estimated Peto odds ratio (OR) 95% confidence intervals (CI) describe strength association between complications; I 2 statistic described proportion inconsistency treatment effect among not due chance. Results found 51 observational studies. was significant increase in risk ischemia (OR 47.7; CI, 9.9-229.3; = 72%, 19 studies) vertebrobasilar 10.8; 3.17-36.7; 0%; eight studies); nonsignificant 2.69; 0.75-9.68; 40%; anterior circulation stroke 2.58; 0.82-8.09; 64%, 13 studies). There were no associations death, myocardial infarction, transient ischemic attacks. incidence phrenic nerve injury complication 4.40% (CI, 1.60%-12.20%). Data on perioperative infection sparse rarely reported. Conclusions Very low quality suggests increases possibly stroke.