Stent-graft therapy for subclavian artery aneurysms and fistulas: single-center mid-term results.
OBJECTIVE
To evaluate the potential of covered stents to replace surgery in the treatment of subclavian artery aneurysms and traumatic injuries.


METHODS
Nine patients (five men, four women; age range, 20-83 years; mean, 54 years) with subclavian artery aneurysms (n = 5) or fistulas (n = 4) were treated with stent-grafts. All devices used were custom-made, consisting of polytetrafluoroethylene (PTFE)-covered Palmaz (n = 5), Wallstent (n = 2), Z stents (n = 8), or a polyester-covered Z stent (n = 1). One patient was lost to follow-up after 2 months. All others were followed up with clinical evaluation, computed tomography (CT), and/or ultrasound.


RESULTS
All devices were deployed successfully with exclusion of the aneurysms and fistulas. There were two procedure-related complications (22%), consisting of groin pseudoaneurysms requiring surgical repair 3 and 9 days after the procedure. One of those patients required additional oral antibiotic therapy for a postsurgical groin wound infection. One patient developed a stenosis at 12 months, which required angioplasty. The stent-graft thrombosed in one patient because of a kink 2 months after placement, which was successfully treated by thrombolysis and placement of a Wallstent. The primary and secondary patencies are 89% and 100%, respectively, after a mean follow-up of 29 months (2-66 mo).


CONCLUSIONS
Mid-term results of stent-graft therapy of subclavian artery aneurysms and fistulas are encouraging, with low morbidity and excellent clinical outcome.
Hilfiker
P R
PR
Department of Cardiovascular and Interventional Radiology, Stanford University, California, USA.
Razavi
M K
MK
Kee
S T
ST
Sze
D Y
DY
Semba
C P
CP
Dake
M D
MD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000601:surgery*; D001164:Arteriovenous Fistula / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D005260:Female; D005465:Fluorocarbon Polymers; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011091:Polyesters; D015607:Stents / Q000009:adverse effects*; D013348:Subclavian Artery / Q000002:abnormalities / Q000293:injuries / Q000601:surgery*; D016896:Treatment Outcome
D005465:Fluorocarbon Polymers; D011091:Polyesters; C010946:polytetrafluoroethane