The Effect of Left Subclavian Artery Coverage in Thoracic Endovascular Aortic Repair

We propose a systematic review that compares outcomes after intentional coverage of the left subclavian artery during thoracic endovascular repair with and without prior surgical revascularization. According to Preferred Items for Reporting of Systemic Reviews and Meta-Analyses guidelines, PubMed and Embase searches identified studies reporting patients with left subclavian artery coverage during thoracic endovascular repair and their subsequent outcomes. Analyzing a varied patient cohort, there are nonstatistically significant trends that favor left subclavian artery revascularization in preventing stroke (odds ratio 0.76, 95% confidence interval: 0.49 to 1.18) and spinal cord ischemia (odds ratio 0.73, 95% confidence interval: 0.38 to 1.38); that was significant in reducing arm-related ischemia (p = 0.02). Further investigations should try to define subgroups of patients who might benefit from revascularization or who would derive no benefit.