Endovascular stenting vs. extrathoracic surgical bypass for symptomatic subclavian steal syndrome.
OBJECTIVE
To analyze the immediate and long-term outcomes of endovascular stenting vs. extrathoracic surgical bypass for subclavian steal syndrome.


METHODS
From 1989 to 2010, 252 consecutive patients (173 men; mean age 62 years) with vertebrobasilar and upper extremity symptoms of subclavian steal were treated with balloon-expandable stents (n=148) or extrathoracic surgical bypasses (n=104: 71 axilloaxillary and 33 carotid-subclavian) using polytetrafluoroethylene grafts.


RESULTS
The technical success rate was 97.3% in the stent group vs. 99.0% for the bypass group (p=0.605). There was no perioperative mortality or any permanent neurological deficit in either group. The overall perioperative complication rate was 6.1% in the stent group vs. 9.6% in the bypass group (p=0.295). The 10-year target vessel revascularization rate was 46.6% for stenting vs. 5.8% for bypass (p<0.001). The cumulative primary patency rates at 1, 3, 5, and 10 years were 91%, 78%, 67%, and 49% for the stent group vs. 99%, 97%, 95%, and 89% for the bypass group (p<0.001). The cumulative secondary patency rates were 95%, 91%, 86%, and 64%, respectively, for the stent group vs. 99%, 99%, 98%, and 94% for the bypass group (p=0.001). No difference was detected in overall survival curves between the groups (p=0.527).


CONCLUSIONS
Both endovascular stenting and extrathoracic surgical bypass are safe and effective treatments for subclavian steal syndrome in the short and medium term; however, extrathoracic surgical bypasses are more durable in the long term.
Department of Vascular Surgery, XuanWu Hospital, and Institute of Vascular Surgery, Capital Medical University, Beijing, China.
Lipo
L
Song
Jian
J
Zhang
Jianxin
J
Li
Yongquan
Y
Gu
Hengxi
H
Yu
Bing
B
Chen
Lianrui
L
Guo
Zhonggao
Z
Wang
D000368:Aged; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002681:China; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D011138:Polytetrafluoroethylene; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013349:Subclavian Steal Syndrome / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
D011138:Polytetrafluoroethylene