title: Endovascular management versus surgery for proximal subclavian artery lesions.
abstract: Current management of subclavian artery (SA) lesions is controversial. Subclavian-to-carotid artery transposition (SCT) may be challenging but exhibits unparalleled long-term results. Stent-supported percutaneous transluminal angioplasty (sPTA) is technically easier but not always feasible. Long-term results and comparisons have not been published. We compared both methods performed by vascular surgeons. Data were collected prospectively with retrospective analysis at a tertiary-care center. sPTA was performed through a retrograde transbrachial access using self-expanding nitinol stents. Open surgery was SCT only. Society for Vascular Surgery/International Society of Cardiovascular Surgery reporting standards were applied. Seventy-four patients underwent treatment from January 1995 to August 2007 (median age 62.6 years, 40 female; left-sided pathology 60 [81.1%]; risk factors: hypertension 45 [60.8%], dyslipidemia 47 [63.5%], diabetes 21 [28.4%], smoking 43 [58.1%], SA occlusion 50 [67.6%]). Forty patients (54.1%) underwent primary sPTA (62.5% occlusions) and 34 SCT (73.5% occlusions). The two groups were comparable with regard to risk factors. In 12 patients occlusions could not be recanalized (30%), and in two stents failed within 1 month (both for stenosis). All but one underwent subsequent uneventful SCT. All SCTs were successful. No risk factor could be identified for treatment failure except sPTA (p = 0.002, Fisher's exact test). Median follow-up was 50.1 months with sPTA and 52.6 months with SCT. No procedure failed during follow-up in either group. sPTA can be performed successfully by surgeons. Primary sPTA failed in 48% of occlusions (30% of all sPTAs). Prediction of failure is not possible. According to our experience, we recommend primary sPTA for SA stenosis and surgery for SA occlusions.
authors.affiliation: Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Salzburg, Austria. k.linni@salk.at
authors.forename: K
authors.initials: K
authors.lastname: Linni
authors.forename: A
authors.initials: A
authors.lastname: Ugurluoglu
authors.forename: N
authors.initials: N
authors.lastname: Mader
authors.forename: W
authors.initials: W
authors.lastname: Hitzl
authors.forename: H
authors.initials: H
authors.lastname: Magometschnigg
authors.forename: Th J
authors.initials: TJ
authors.lastname: Hölzenbein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D013349:Subclavian Steal Syndrome / Q000473:pathology / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects
chemical_list: D000497:Alloys; C013616:nitinol