The Safety Of Chimneys And Bypass In The Reconstruction Of The Left Subclavian Artery During Thoracic Aortic Repair: A Systematic Review And Meta-analysis

Objective: there are five methods for the reconstruction of the left subclavian artery after thoracic aortic repair with occlusion of the left subclavian artery.In this paper,the incidence of complications after chimney technique and bypass surgery was meta analyzed to compare the safety of the two methods.Methods: literatures related to thoracic aortic repair from January 2000 to October2018 were searched,and the included subjects were sorted out and evaluated.Statistical analysis was conducted through software Review manager 5.3.Results: the incidence of posterior endoleak of left subclavian artery during TEVAR reconstruction in the chimney group was higher than that in the bypass group,and the difference was statistically significant(P < 0.05).There was no significant difference in all-cause mortality within 30 days after the reconstruction of the left subclavian artery during TEVAR between the bypass group and the chimney group(P > 0.05).There was no significant difference in the incidence of acute spinal ischemia after the reconstruction of left subclavian artery during TEVAR between the bypass group and the chimney group(P > 0.05).Patients in the bypass group and the chimney group had TEVAR.Conclusion: there was no significant difference in all-cause mortality,acute spinal cord ischemia and incidence of craniocerebral neurological symptoms after left subclavian artery reconstruction by bypass and TEVAR.Chimney art higher incidence of endoleak after bypass surgery group,but the total incidence rate is low,mainly for ?type of endoleak,a few is ? model of endoleak,rectified after timely intervention and postoperative observation,not related deaths.Both methods are suitable for the reconstruction of the left subclavian artery,with lower incidence of postoperative complications and better safety,and can be flexibly selected according to clinical needs.