Outcome of conservative versus interventional treatment of subclavian artery stenosis.
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.
Schillinger
Martin
M
Department of Internal Medicine II, Division of Angiology, University of Vienna Medical School, Vienna, Austria. martin.schillinger@akh-wien.ac.at
Haumer
Markus
M
Schillinger
Sabine
S
Mlekusch
Wolfgang
W
Ahmadi
Ramazanali
R
Minar
Erich
E
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