Debranching versus Fenestrated Repair for Left Subclavian Artery Revascularisation during Thoracic Endovascular Aortic Repair: The DEFENCE Multicentre Study
Year: 2025
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: To compare the early and midterm outcomes of left subclavian artery revascularization during thoracic endovascular aortic repair (TEVAR) following carotid subclavian bypass/transposition (CSB) vs. fenestrated repair when landing in zone 1/2. Propensity score matching (PSM) was applied to adjust for baseline differences. METHODS: DEbranching versus FENestrated Repair for Left SubClavian Artery REvascularisation (DEFENCE) was a retrospective, international multicentre observational study conducted between January 2019 and July 2023 on consecutive patients who underwent open debranching or fenestration of the left subclavian artery before TEVAR for various aortic arch and descending aortic pathologies. PSM (68 pairs) was performed using logistic regression. Primary endpoints included technical success and 30-day outcomes. Secondary endpoints included re-intervention, death, and aortic related complications at 12, 24, and 36 months. RESULTS: 275 patients were included (198 CSB-TEVAR and 77 FTEVAR). Before PSM, statistically significant differences existed in patient demographics and the distribution of aortic pathology. In the matched cohort, CSB-TEVAR demonstrated higher overall re-intervention rates (15% vs. 3%, p = .031) and aortic related re-intervention rates (15% vs. 3%, p = .031) compared with FTEVAR. No statistically significant differences were observed in overall mortality rates (7% vs. 13%, p = .40) or aortic related mortality rate (3% vs. 3%, p = 1.0). Kaplan-Meier analysis indicated a statistically significant trend towards increased late re-intervention in the CSB-TEVAR group (log rank p = .019). Cox regression revealed that carotid subclavian bypass was associated with a fivefold increased independent risk of overall and aortic related re-interventions (hazard ratio 5.185, 95% confidence interval 1.13 - 23.86, p = .035). CONCLUSION: CSB-TEVAR and FTEVAR achieved high technical success, long term durability, and similar mortality rates. FTEVAR is a durable, low re-intervention alternative, while CSB-TEVAR remains a practical option in urgent cases despite its higher incidence of peri-operative and access related morbidity.
Authors: Ahmed Azhar Ali, Tilo Kölbel, Luca Bertoglio, Anders Wanhainen, Giovanni Pratesi, Stephen Cheng, Csaba Csobay-Novak, Nuno Dias, Florian K. Enzmann, Donald Adam, Nikolaos Tsilimparis, Jan Stana, Giuseppe Panuccio, Martina Cambiaghi, Kevin Mani, Vaiva Dabravolskaitė, Martina Bastianon, Jacky Tam, Nivedita Mitta, Angelos Karelis, Michaela Kluckner, Maciej Juszczak
Institutions: Mansoura University, Mansoura University Hospital, Ludwig-Maximilians-Universität München, University Medical Center Hamburg-Eppendorf, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, University of Brescia, Uppsala University, Uppsala University Hospital, University of Genoa, Queen Mary Hospital, University of Hong Kong, Semmelweis University, Lund University, Skåne University Hospital, Innsbruck Medical University, Universität Innsbruck, University Hospitals Birmingham NHS Foundation Trust, LMU Klinikum
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,000
OpenAlex ID: W4417148010