Percutaneous transluminal angioplasty of the brachiocephalic vessels: guidelines for therapy.
Angioplasty of the brachiocephalic vessels has been utilized in the treatment of stenotic/occlusive lesions for the past twelve years. The guidelines for use of PTA therapy versus surgery, however, have not been well defined. Multiple pathologies and morphologies for the various lesions have been described. The location of the lesion on the brachiocephalic chain plays a role. In our study of 131 brachiocephalic vessels (66 subclavian, 3 axillary, 3 brachial, 35 vertebral, 9 innominate, 6 common carotid, 7 internal carotid and 2 external carotid), we successfully dilated 93% (122/131) of all vessel stenoses/occlusions. Our success rate varied, however, with the severity, pathology, and location of the lesion. [We experienced greater success with stenotic versus occlusions (98%, 118/121 for stenotic lesions, versus 40%, 4/10 for total occlusions)]. In addition, we experienced only 2 complications in our series, a thromboembolism to the arm, and one patient with temporary bilateral blindness. Both patients experienced full recovery. Following PTA therapy, a 5 year follow-up was attempted. Although not complete, we have documented only 5 patients with restenoses at the site of original angioplasty. The restenoses occurred at 3, 6, 8, 12, and 18 months post procedure. Two of the long-term failures were from totally occluded vessels. Through our results, as well as a thorough review of the current literature, we have defined five lesions in which PTA therapy would be superior to surgical intervention.
Motarjeme
A
A
Midwest Vascular Institute, Downers Grove, Illinois.
Gordon
G I
GI
D000792:Angiography; D000800:Angioplasty, Balloon; D001161:Arteriosclerosis / Q000000981:diagnostic imaging / Q000628:therapy*; D001366:Axillary Artery / Q000000981:diagnostic imaging; D001916:Brachial Artery / Q000000981:diagnostic imaging; D016122:Brachiocephalic Trunk / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D005352:Fibromuscular Dysplasia / Q000000981:diagnostic imaging / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D013349:Subclavian Steal Syndrome / Q000000981:diagnostic imaging / Q000628:therapy*; D014654:Vascular Patency / Q000502:physiology; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging / Q000628:therapy*