Left subclavian artery occlusion during endovascular repair of traumatic thoracic aortic injury, cohort study
Bibliographic record
Abstract
ABSTRACT Background: Thoracic endovascular aortic repair (TEVAR) is superior to open techniques, as it is a minimally invasive procedure with low morbidity and mortality rates. The aortic isthmus is usually the rupture site in aortic thoracic injuries. Therefore, the distance from the left subclavian artery (LSA) usually allows proximal stent graft fixation. The main challenge is the intentional coverage of the LSA without revascularization, which is necessary to expand the proximal landing zone and to achieve an adequate seal. Acute arm ischemia, claudication, stroke, and/or left subclavian steal syndrome may occur during intentional occlusion of the LSA without revascularization when performing thoracic aorta lesion endovascular repair. The present study was conducted to analyze the safety of coverage of the LSA without revascularization during the endovascular treatment of traumatic thoracic aorta injuries. Methods: A retrospectively collected data set from two trauma centers in Saudi Arabia was reviewed between April 2007 and January 2018 to analyze the safety of LSA coverage during TEVAR performed for traumatic thoracic aorta transection. In this data set, 69 patients presented with descending thoracic aortic injuries. All were treated urgently with TEVAR with intentional LSA occlusion without revascularization during aortic injury endovascular repair. Those who underwent thoracotomy and pre-TEVAR patients who died were excluded from this study. Results: A total of 69 patients underwent intentional left subclavian artery (LSA) coverage without revascularization during the procedure; the primary technical success reached 94.2% for patients who underwent TEVAR for traumatic aortic transection. The clinical success rate was 98.6%. Only 1 of 69 patients with LSA coverage developed a localized ischemic stroke (1.4%). The 30-day mortality rate was 4.3% due to multiple organ failure. Conclusion: Revascularization of LSA is not mandatory with TEVAR for treating traumatic thoracic aortic injury with an inadequate proximal landing zone. Extending the landing zone to zone 2 and coverage of LSA is considered safe and non-time-consuming, especially in urgent situations. It provides better fixation and a good sealing zone. Highlights:
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".