This registry study compared perioperative and follow-up outcomes of three left subclavian artery (LSA) revascularization strategies during zone 2 TEVAR: carotid-subclavian bypass (CSB)+TEVAR, branched TEVAR, and fenestrated TEVAR, using the SVS Vascular Quality Initiative TEVAR registry (2013–2026) across 113 centers.
Among 723 patients, in-hospital mortality (3.2% vs. 1.0% vs. 3.6%), stroke (5.9% vs. 2.9% vs. 5.4%), and spinal cord ischemia (3.0% vs. 4.9% vs. 0.9%) did not differ significantly across CSB+TEVAR, branched TEVAR, and fenestrated TEVAR; however, CSB+TEVAR had greater blood loss, longer procedure time, and longer postoperative stay, while side-arm branched TEVAR was associated with lower odds of pre-discharge aortic reintervention.
Propensity-matched subgroup analyses were limited by small matched sample sizes, reducing statistical power for pairwise comparisons. As a registry study, unmeasured confounding by anatomy, device availability, and institutional experience cannot be excluded. Freedom from sac enlargement differed significantly by group but the clinical implications were not fully characterized.
CSB+TEVAR, branched TEVAR, and fenestrated TEVAR all appear to be acceptable LSA revascularization options during zone 2 TEVAR with broadly similar safety profiles; choice should be individualized based on patient anatomy, device availability, and institutional expertise rather than a single preferred approach.
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