The Society for Vascular Surgery Practice Guidelines: Management of the left subclavian artery with thoracic endovascular aortic repair
Received 18 August 2009; accepted 19 August 2009.
The Society for Vascular Surgery pursued development of clinical practice guidelines for the management of the left subclavian artery with thoracic endovascular aortic repair (TEVAR). In formulating clinical practice guidelines, the society selected a panel of experts and conducted a systematic review and meta-analysis of the literature. They used the grading of recommendations assessment, development, and evaluation (GRADE) method to develop and present their recommendations. The overall quality of evidence was very low. The committee issued three recommendations. Recommendation 1: In patients who need elective TEVAR where achievement of a proximal seal necessitates coverage of the left subclavian artery, we suggest routine preoperative revascularization, despite the very low-quality evidence (GRADE 2, level C). Recommendation 2: In selected patients who have an anatomy that compromises perfusion to critical organs, routine preoperative LSA revascularization is strongly recommended, despite the very low-quality evidence (GRADE 1, level C). Recommendation 3: In patients who need urgent TEVAR for life-threatening acute aortic syndromes where achievement of a proximal seal necessitates coverage of the left subclavian artery, we suggest that revascularization should be individualized and addressed expectantly on the basis of anatomy, urgency, and availability of surgical expertise (GRADE 2, level C).
Correspondence: Jon S. Matsumura, MD, Division of Vascular Surgery, University of Wisconsin School of Medicine and Public Health, G5/325 Clinical Science Center, 600 Highland Ave, Madison, WI 53792
Competition of interest: Dr Matsumura received research support, consultation fees, or training director fees from Abbott, Cook, ev3, Lumen, Medtronic, and WL Gore. Dr Lee received research support and consultation fees from Cook, Medtronic, and Bolton Medical. Dr Farber received consultant fees from WL Gore, Medtronic, Cook, Aptus Endosystems, and Bolton Medical. Dr Lumsden received consultation fees and speaker bureau fees from BSCI, WL Gore, Medtronic, and VNUS Medical. He is a stockholder in Hatch Medical and Northpoint Domain. His spouse is an employee of Medtronic. Dr Greenberg received research support from Cook Inc and WL Gore. He has IP/license agreements with Cook Inc. Dr Fairman received research support from Abbott, Medtronic, Cook, Aptus, and Boston Scientific.
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