• Hung-Lung Hsu, Chen-Ming Huang, Yin-Yin Chen, Fu-Chien Hsieh, and Jer-Shen Chen.
• Department of Cardiovascular Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Cardiovascular Surgery, Department of Surgery, Mennonite Christian Hospital, Hualien, Taiwan.
• Ann Vasc Surg. 2017 Feb 1; 39: 152-159.

BackgroundTo evaluate the safety and efficacy of the sandwich technique with the body flossing wire to revascularize the left subclavian artery (LSA) in thoracic endovascular aortic repair (TEVAR).MethodsFrom April 2014 to April 2015, 20 consecutive patients with a variety of thoracic aortic pathologies who underwent LSA revascularization with the sandwich technique and body flossing wire during TEVAR were included. Outcomes including technical success, endoleaks, perioperative mortality and morbidity, and graft patency were analyzed.ResultsThere were 13 patients (65.0%) who presented with aortic dissection, 3 (15.0%) with thoracic aortic aneurysm, 3 (15.0%) with penetrating aortic ulcer, and 1 (5.0%) with traumatic aortic disruption. Technical success rate was 100%. But one type Ia endoleak (5.0%) was noted and treated with extended endografting. One sandwiched gutter leak (5.0%) resolved spontaneously at 6 months. One sandwiched graft (5.0%) was occluded but not treated because no related complications were found. At a mean follow-up of 9.7 months (range 4-17), all the patients with aortic aneurysm, penetrating aortic ulcer, or traumatic aortic disruption had complete thrombosis of the aortic pathologies. Patients with aortic dissection had thrombosed false lumen down to the distal aortic endograft edge (12/13, 92.3%) or the celiac artery level (8/13, 61.5%). There was no neurological deficit but 2 non-procedure-related late deaths during the study period.ConclusionsOur early experience showed that the sandwich technique with the body flossing wire to maintain blood flow to the LSA is a safe and effective method. This technique can be applied in various clinical situations with a high technique success rate. However, outcomes are preliminary and larger studies are required.Copyright © 2016 Elsevier Inc. All rights reserved.

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