Objective: To investigate the prognostic impact of coverage of the left subclavian artery (LSA) without prior revascularization during thoracic endovascular aortic repair (TEVAR). Methods: The clinical data of 76 patients with thoracic lesions undergoing TEVAR between June 2007 and January 2012 were retrospectively analyzed. The lesions comprised aortic dissection (56 cases), intramural hematoma (6 cases), thoracic aneurysm(5 cases) and traumatic rupture of the thoracic aorta (9 cases). Of the patients, 32 cases underwent TEVAR with complete LSA coverage, 9 cases with partial LSA coverage and 35 cases without LSA coverage. The clinical outcomes and complications of the patients were analyzed . Results: One patient (1.3%) died of acute stroke during perioperative period. Of the 32 patients with LSA coverage, cerebrovascular accident occurred in 3 cases (9.4%), left upper extremity claudication developed in 4 patients (12.5%) and left subclavian steal syndrome appeared in one case (3.1%). The follow-up ranged from 3 to 40 months, during which one patient died, and type I endoleak occurred in 2 patients and was resolved by a second surgical intervention. Conclusion: Selective primary LSA coverage during TEVAR is practicable.