How I do it: Established and novel methods for left subclavian revascularization with thoracic endovascular aortic repair.

Left subclavian artery revascularization at the time of thoracic endovascular aortic repair has been the subject of discussion for over a decade. Contemporary viewpoints suggest that revascularization should be performed where possible to decrease the risk of perioperative stroke, spinal cord ischemia, and, to a lesser degree, loss of upper extremity function. In this article, we present traditional methods as well as descriptions of newer options and technology for preservation of left subclavian artery flow during thoracic endovascular aortic repair.

Left carotid chimney and left subclavian artery laser fenestration for zone 1 thoracic endovascular aortic repair.

Thoracic endovascular aortic repair has become an increasingly used option for treatment of descending thoracic aortic aneurysms and dissections. Pathology involving the proximal thoracic aorta is more complex and requires revascularization of the subclavian and carotid arteries. We report a case of an arch thoracic aortic pseudoaneurysm repaired via a complete endovascular approach using a left carotid chimney and left subclavian artery laser fenestration.