title: Outcomes of endoluminal therapy for ostial disease of the major branches of the aortic arch.
abstract: While aggressive endoluminal therapy for occlusive disease of the major branches of the arch of the aorta (brachiocephalic [BCA], left common carotid [LCCA], and left subclavian [LSCA] arteries) is commonplace, long-term outcomes in this population are unclear. We examined the long-term outcomes of endoluminal therapy for ostial aortic arch disease at a single tertiary referral academic medical center. A prospective database of patients undergoing endovascular treatment of aortic arch vessel atherosclerotic occlusive disease between 1990 and 2004 was maintained and retrospectively analyzed. Patients with stenotic ostial lesions of the major thoracic aorta branches were selected. Angiograms were reviewed in all cases to assess lesion characteristics. Patency was assessed by routine clinical and, in the LCCA and LSCA, duplex ultrasound follow-up at 1, 6, and 12 months postintervention and every 12 months thereafter. Results were standardized to current Trans-Atlantic Inter-Society Consensus and Society for Vascular Surgery criteria. Kaplan-Meier analyses were performed to assess time-dependent outcomes. Factor analyses were performed using a Cox proportional hazard model for time-dependent variables. Data are presented as mean +/- SEM. Forty-four patients (average age 64 +/- 2 years, 59% male) underwent 26 LSCA, 11 LCCA, and eight BCA interventions for primary indications of arm ischemia (29%), prevention or treatment of coronary steal syndrome (29%), or cerebrovascular signs/symptoms (42%). The technical success rate was 98%, with a 90-day mortality rate of 0% and a major adverse event rate of 2%. There were no strokes and no upper extremity embolic events. Cumulative patency was 88 +/- 8% at 3 years, with a reintervention rate of 7%. The overall symptom recurrence rate was 4%. No local or systemic factors were associated with poor outcomes. Endoluminal stenting for ostial disease of the branches of the aortic arch provides excellent and long-term patency rates with low morbidity, mortality, and secondary intervention rates. With an overall technical success of 98%, our results parallel those for lesions located more distally in the arch branches and support the continued use of percutaneous therapy for atherosclerotic disease throughout the arch branches.
authors.affiliation: Department of Surgery, Center for Vascular Disease, University of Rochester, Rochester, NY 14642, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Bakken
authors.forename: Eugene
authors.initials: E
authors.lastname: Palchik
authors.forename: Wael E
authors.initials: WE
authors.lastname: Saad
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Hart
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Singh
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Rhodes
authors.forename: David L
authors.initials: DL
authors.lastname: Waldman
authors.forename: Mark G
authors.initials: MG
authors.lastname: Davies
mesh_terms: D000368:Aged; D001132:Arm / Q000098:blood supply; D050197:Atherosclerosis / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D016122:Brachiocephalic Trunk / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D017536:Carotid Artery, Common / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000601:surgery; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D013348:Subclavian Artery / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency