The Society for Vascular Surgery Practice Guidelines: Management of the left subclavian artery with thoracic endovascular aortic repair

Jon S. Matsumura, W. Anthony Lee, R. Scott Mitchell, Mark A. Farber, Mohammad Hassan Murad, Alan B. Lumsden, Roy K. Greenberg, Hazim J. Safi, Ronald M. Fairman

Research output: Contribution to journalArticle

247 Scopus citations

Abstract

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).

Original languageEnglish (US)
Pages (from-to)1155-1158
Number of pages4
JournalJournal of vascular surgery
Volume50
Issue number5
DOIs
StatePublished - Nov 1 2009

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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    Matsumura, J. S., Lee, W. A., Mitchell, R. S., Farber, M. A., Murad, M. H., Lumsden, A. B., Greenberg, R. K., Safi, H. J., & Fairman, R. M. (2009). The Society for Vascular Surgery Practice Guidelines: Management of the left subclavian artery with thoracic endovascular aortic repair. Journal of vascular surgery, 50(5), 1155-1158. https://doi.org/10.1016/j.jvs.2009.08.090