{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T11:16:01Z","timestamp":1784200561373,"version":"3.55.0"},"reference-count":38,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,3,17]],"date-time":"2025-03-17T00:00:00Z","timestamp":1742169600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Endovasc Ther"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>This meta-analysis aimed to compare postoperative outcomes between endovascular and surgical revascularization of the left subclavian artery (LSA) in patients undergoing thoracic endovascular aortic repair (TEVAR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We performed a comprehensive search of the MEDLINE and EMBASE databases through February 2024. Pooled results were calculated, and subgroup analyses focused on the chimney technique for LSA revascularization. Kaplan\u2013Meier curves for mid-term all-cause mortality were reconstructed by extracting time-to-event data from the included studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Twelve nonrandomized studies, including a total of 4158 patients, were analyzed. Procedural duration was significantly longer in the surgical revascularization cohort (p\u2009&lt;\u20090.01). No statistically significant differences were found in other short-term outcomes between the 2 groups. However, subgroup analysis of studies focusing on the chimney technique showed that surgical revascularization was associated with a significantly lower rate of postoperative endoleak [odds ratio; OR (95% confidence interval; CI)\u2009=\u20090.17 (0.06\u20130.49), p\u2009&lt;\u20090.01]. For mid-term outcomes, there were no significant differences in mortality [hazards ratio; HR (95% CI)\u2009=\u20091.25 (0.71\u20132.22), p\u2009=\u20090.44], aortic re-intervention rate [HR (95% CI)\u2009=\u20091.10 (0.49\u20132.47), p\u2009=\u20090.81], or LSA patency rate [HR (95% CI)\u2009=\u20091.24 (0.40\u20133.89), p\u2009=\u20090.71] between the 2 strategies. The follow-up endoleak rate tended to be lower in the surgical revascularization group [HR (95% CI)\u2009=\u20090.50 (0.24\u20131.03), p\u2009=\u20090.06], with a more pronounced trend in the subgroup analysis of studies exclusively employing the chimney technique [HR (95% CI)\u2009=\u20090.33 (0.10\u20131.02), p\u2009=\u20090.05], though the differences were not statistically significant. Reconstructed Kaplan\u2013Meier curves for all-cause mortality indicated no significant difference in mid-term survival between the groups [HR (95% CI)\u2009=\u20090.94 (0.74\u20131.19), p\u2009=\u20090.60].<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>This meta-analysis reveals comparable postoperative outcomes between surgical and endovascular LSA revascularization in patients undergoing TEVAR. However, the chimney technique was associated with a higher rate of postoperative endoleak.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Impact<\/jats:title>\n                    <jats:p>This meta-analysis provides insights into the comparative effectiveness of surgical versus endovascular left subclavian artery (LSA) revascularization during thoracic endovascular aortic repair (TEVAR). While both techniques demonstrated comparable short- and mid-term outcomes, the chimney stent-graft technique showed a higher incidence of postoperative endoleak, suggesting a need for careful patient selection and follow-up. These findings will guide clinicians in optimizing LSA revascularization strategies and balancing procedural risks with postoperative outcomes in patients requiring LSA coverage during TEVAR.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15266028251324804","type":"journal-article","created":{"date-parts":[[2025,3,17]],"date-time":"2025-03-17T07:31:22Z","timestamp":1742196682000},"page":"1986-2002","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of Postoperative Outcomes Between Endovascular and Surgical Revascularization of the Left Subclavian Artery in Patients Undergoing Thoracic Endovascular Aortic Repair: Systematic Review and Meta-Analysis"],"prefix":"10.1177","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1789-5993","authenticated-orcid":false,"given":"Noritsugu","family":"Naito","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8048-125X","authenticated-orcid":false,"given":"Hisato","family":"Takagi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,3,17]]},"reference":[{"key":"e_1_3_3_2_2","article-title":"2022 ACC\/AHA Guideline for the diagnosis and management of aortic disease: a report of the American Heart Association\/American College of Cardiology Joint Committee on Clinical Practice Guidelines","volume":"80","author":"Peer Review Committee Members","year":"2022","unstructured":"Peer Review Committee Members, Isselbacher EM, Preventza O, et al 2022 ACC\/AHA Guideline for the diagnosis and management of aortic disease: a report of the American Heart Association\/American College of Cardiology Joint Committee on Clinical Practice Guidelines. 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