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TEVAR Left Subclavian Coverage Complications — FRCA Final MCQ

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HardCardiothoracic AnaesthesiaTEVAR Left Subclavian Coverage ComplicationsFRCA Final

A 60-year-old man (ASA III) with a thoracic aortic aneurysm undergoes endovascular thoracic aortic repair (TEVAR). The stent graft covers the left subclavian artery origin. What complication is he at risk of developing?

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Correct answer: D — Left arm claudication and posterior circulation stroke from vertebral artery coverage

Covering the left subclavian artery origin during TEVAR deprives the left vertebral artery (usually arising from the left subclavian) of antegrade flow, risking posterior circulation stroke (brainstem, cerebellum, occipital cortex) and left arm claudication/ischaemia. Pre-operative left subclavian artery revascularisation (carotid-subclavian bypass or transposition) should be performed before TEVAR if the left subclavian artery will be covered, particularly if: dominant left vertebral artery, left internal mammary artery CABG graft, or left arm AV fistula. Spinal cord ischaemia risk also increases when the left subclavian is covered.

Reference: NICE – 2020 – TEVAR guidelines; RCOA – 2023 – Vascular/cardiothoracic anaesthesia