Background Endovascular thoracic aortic treatment frequently requires extending the proximal landing zone up into the aortic arch with consecutive covering of the left subclavian artery orifice. Our aim was to report on our outcome of left subclavian artery revascularization using carotid-subclavian bypass via lateral access to the subclavian artery.

Methods Patients' charts in our aortic center were screened for all those who had undergone carotid-subclavian bypass during endovascular thoracic aortic repair procedures. We analyzed perioperative complications such as cervical plexus nerve or phrenic nerve injury, bleeding, and primary and follow-up graft patency.

Results Between 2001 and 2020, 118 patients underwent carotid-subclavian bypass implantation. Postoperative complications included left-sided stroke in 3% and axillary, phrenic, and recurrent laryngeal nerve palsy in 3, 2, and 3%, respectively. Carotid-subclavian bypass–related death rate was 0%. Bypass patency was 92 ± 7% at 5 years. We documented nine (8%) bypass late occlusions with one left upper extremity ischemia and one late stroke due to an embolized thrombus formed at the bypass anastomosis. All others were asymptomatic.

Conclusion Carotid-subclavian bypass surgery is associated with very low risk of death, stroke, or any nerve palsy. Lateral access to the left subclavian artery reduces the risk of phrenic nerve injury.

背景 血管内胸主动脉治疗通常需要将近端着陆区向上延伸至主动脉弓，并连续覆盖左锁骨下动脉口。我们的目的是报告我们使用颈动脉-锁骨下旁路术通过锁骨下动脉外侧入路进行左锁骨下动脉血运重建的结果。

方法 对 我们主动脉中心的患者病历进行筛选，以查找在血管内胸主动脉修复手术期间接受颈动脉-锁骨下动脉旁路手术的所有患者。我们分析了围手术期并发症，例如颈丛神经或膈神经损伤、出血以及初次和随访移植物通畅率。

结果 2001 年至 2020 年间，118 名患者接受了颈动脉-锁骨下动脉旁路植入术。术后并发症包括 3% 的左侧中风和分别为 3%、2% 和 3% 的腋神经、膈神经和喉返神经麻痹。颈动脉-锁骨下动脉搭桥术相关死亡率为 0%。5 年时旁路通畅率为 92 ± 7%。我们记录了 9 例 (8%) 旁路晚期闭塞，其中 1 例左上肢缺血，1 例晚期卒中是由于旁路吻合处形成的栓塞血栓。其他人都没有症状。

结论 颈动脉-锁骨下动脉旁路手术与死亡、中风或任何神经麻痹的风险非常低相关。从侧面进入左锁骨下动脉可降低膈神经损伤的风险。