title: Outcome of conservative versus interventional treatment of subclavian artery stenosis.
abstract: OBJECTIVE
  To compare the outcome of conservative treatment versus percutaneous transluminal angioplasty (PTA) of subclavian artery stenosis in terms of long-term hemodynamic and symptomatic outcome in a retrospective, nonrandomized study.
  
  
  METHODS
  Within a 14-year period, 295 consecutive inpatients were treated for subclavian artery stenosis. Excluding 21 (7%) surgical cases, the remaining 274 patients were treated either conservatively (n = 165) or with PTA (n = 109). Medical history, physical findings, and sonographic and angiographic data were recorded from the medical records of the 223 (81%) patients who were followed until the year 2000; 166 patients were then reinvestigated with oscillography, Doppler measurements, and duplex sonography. Outcomes of conservative versus interventional therapy were analyzed based on the intention to treat principle.
  
  
  RESULTS
  After a median 42-month follow-up (interquartile range 18-85), patients treated with PTA had a 60% risk reduction for hemodynamic subclavian stenosis compared to conservative treatment (adjusted hazard ratio 0.4, 95% confidence interval 0.2-0.6, p<0.0001). However, the risk of having a symptomatic stenosis at the time of follow-up did not differ between the treatment groups (p=0.3).
  
  
  CONCLUSIONS
  Endovascular revascularization improves the long-term hemodynamic outcome in patients with subclavian stenosis, but many conservatively treated patients become asymptomatic during follow-up. Interventional treatment may be considered primarily for patients with severe symptoms of vertebrobasilar insufficiency, critical ischemia, or peripheral emboli.
authors: Department of Internal Medicine II, Division of Angiology, University of Vienna Medical School, Vienna, Austria. martin.schillinger@akh-wien.ac.at
authors: Martin
authors: M
authors: Schillinger
authors: Markus
authors: M
authors: Haumer
authors: Sabine
authors: S
authors: Schillinger
authors: Wolfgang
authors: W
authors: Mlekusch
authors: Ramazanali
authors: R
authors: Ahmadi
authors: Erich
authors: E
authors: Minar
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D001161:Arteriosclerosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013348:Subclavian Artery; D013997:Time Factors; D016896:Treatment Outcome