Brachiocephalic Artery Debranching to Facilitate Thoracic Endografting
Current requirements for thoracic aortic endografting, based on device Instructions for Use (IFU), include a proximal aortic “neck” measuring at least 2 cm in length. Not infrequently, this neck length is not available in patients with more proximal aneurysmal disease of the descending thoracic aorta, necessitating coverage of the brachiocephalic trunks (most commonly the left subclavian artery) or preemptive revascularization (either bypass with proximal ligation or transposition). The current literature suggests that the intentional coverage of the left subclavian artery during placement of a thoracic endograft may increase the risk of arm ischemia, vertebrobasilar ischemia, and possibly spinal cord ischemia and anterior circulation stroke. When feasible, revascularization should be performed to reduce this risk. In addition, challenging anatomy may increase the risk of inadvertent endograft coverage of the brachiocephalic trunks.