OBJECTIVE: To compare the midterm outcomes of fenestration, branched stent-graft thoracic endovascular aortic repair, and hybrid procedures in treating aortic arch pathologies involving the left subclavian artery. METHODS: We collected the clinical data from 144 patients with aortic arch pathologies involving and only involving the left subclavian artery (LSA) who underwent fenestration, branched stent-graft thoracic endovascular aortic repair, and hybrid procedures from November 2015 and December 2022 at a single center. Among the patients, 68 were treated by fenestration, 61 by branched stent-grafts, and 15 by hybrid surgery. The clinical data was retrospectively analyzed and compared. The primary outcome indicators included technical success and in-hospital mortality
others included the incidence of endoleaks, spinal cord ischemia, LSA patency, stent-related entry tear, aortic-related reintervention, operative time, blood loss, and aortic remodeling. RESULTS: The technical success rate was 83.8%, 95.1%, and 100% ( CONCLUSION: The fenestration technique is sophisticated with long learning curve and is prone to complications such as endoleaks with inexperience. Branched grafts are at greater risk of stent-related entry tears, which result in a higher rate of re-intervention. The hybrid technique broadens the indications for patients with aortic arch vessel variation and generally costs less, but the operative time is longer. Surgeons should select the optimal solution based on each patient's condition to achieve satisfactory results.