Management of the Left Subclavian Artery during TEVAR

The proximity of thoracic aortic pathologies to the left subclavian artery has occasionally required intentional coverage of this vessel. With increased collective experience with thoracic endovascular techniques, indications for revascularization in this setting have evolved. Coverage of the left subclavian artery without revascularization has been associated with left arm claudication, spinal cord ischemia, posterior circulation strokes, and, in certain instances, myocardial ischemia. The occurrence of these events has not been uniform and, in some patients, the left subclavian artery can be covered without significant clinical sequelae. In this review, we discuss the incidence of these complications, their risk factors, and indications for elective revascularization of the left subclavian artery during thoracic endovascular aortic repair.