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La Bitácora de Cirugía Vascular

Arteria subclavia izquierda y reparación endovascular de los aneurismas de aorta torácica

Arteria subclavia izquierda y reparación endovascular de los aneurismas de aorta torácica

La reparación endovascular de la aorta torácica (REVAT) para el tratamiento de aneurimas y disecciones es una técnica que está evolucionando rápidamente, y es mucho más atractiva que la reparación abierta mediante toracotomía, que está asociada a una morbilidad y mortalidad nada despreciable. Sin embargo, el ictus, la isquemia medular y otras complicaciones asociadas con la reparación abierta también pueden aparecer en la REVAT.

Hasta un 40% de los pacientes sometidos a REVAT tienen patología que se extiende hasta la subclavia izquierda. En esta situación, lo usual es cubrir la subclavia izquierda con la endoprótesis. Sin embargo, el riesgo de complicaciones en estos pacientes parece estar aumentado. Un metanalisis recién publicado en J Vasc Surg muestra, en estos casos, una tasa del 6% de isquemia del brazo, 4% de isquemia medular, 2% de isquemia vertebrobasilar, un 5% de ictus y una mortalidad del 6%.

¿La revascularización profiláctica de la arteria subclavia reduce estas complicaciones? Pues no está muy claro, ya que no se dispone de estudios de calidad para responder a la pregunta. Sin embargo, la Society for Vascular Surgery, en una Guía de Práctica Clínica publicada junto al anterior metanálisis, recomienda de la revascularización rutinaria de la subclavia, sobretodo, en los casos en los que la anatomía comprometa la perfusión a órganos críticos.

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