{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T15:05:12Z","timestamp":1789571112321,"version":"build-2803163510"},"reference-count":71,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Cardiovasc. Dev. Dis.","JCDD"],"abstract":"<jats:p>Management of the left subclavian artery (LSA) during aortic arch surgery is complex due to its deep anatomical location and potential pathological alterations, posing risks such as stroke, spinal cord injury, and recurrent laryngeal nerve damage. Revascularization of the LSA is critical in various clinical scenarios to maintain adequate perfusion to the vertebral arteries, spinal cord, and upper limb, especially in patients with anatomical variations, prior bypass surgeries, or increased risk of ischemia. Coverage of the LSA during thoracic endovascular repair (TEVAR) without revascularization significantly increases stroke and spinal cord ischemia rates. We provided a narrative review, evaluating contemporary open and endovascular options for the treatment of the aortic arch, and consequently of the LSA. Frozen elephant trunk (FET), endovascular strategies (branched and fenestrated TEVAR), but also emerging hybrid devices, are all valuable treatments with respective strengths and limitations to be understood to obtain the best patient-prosthesis match. Individualized treatment selection based on pathology, urgency, and patient factors is essential to optimize outcomes. This evolving paradigm integrates open and endovascular techniques to enhance patient care in complex aortic arch disease.<\/jats:p>","DOI":"10.3390\/jcdd13090468","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T13:50:27Z","timestamp":1789566627000},"page":"468","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Management of Left Subclavian Artery in Aortic Open and Endovascular Surgery"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6154-9111","authenticated-orcid":false,"given":"Federico","family":"Giorgi","sequence":"first","affiliation":[{"name":"Cardiac Surgery Division, Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8779-9120","authenticated-orcid":false,"given":"Nicola","family":"Troisi","sequence":"additional","affiliation":[{"name":"Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Besola","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Division, Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danilo","family":"Ruggiero","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Division, Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Ravenni","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Division, Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Celiento","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Division, Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2724-3961","authenticated-orcid":false,"given":"Andrea","family":"Colli","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Division, Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/j.jvs.2021.08.080","article-title":"A systematic review and meta-analysis of the incidence of acute aortic dissections in population-based studies","volume":"75","author":"Caldeira","year":"2022","journal-title":"J. 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