Ten-year experience in subclavian revascularisation. A parallel comparative observational study.
BACKGROUND
Subclavian stenosis has a prevalence of approximately 2% in the community, and 7% within a clinical population. It is closely linked with hypertension and smoking. There is a relative paucity of published data to inform clinicians on the optimal mode of treatment for subclavian artery stenosis.


OBJECTIVE
To compare clinical outcomes of subclavian bypass surgery with that of subclavian endovascular re-vascularisation. Endpoints were survival time, re-intervention-free survival, and symptom-free survival.


METHODS
In all, 21 subclavian interventions were performed from 2000 to 2010. We compared angioplasty vs angioplasty with stenting vs bypass.


RESULTS
Technical success was 100% in all groups. Symptom-free survival, at 70 months, was 60% in the angioplasty group, 100% in the angioplasty and stenting group and 75% in the bypass group. Re-intervention rate was 40% in the angioplasty group, 0% in the angioplasty and stenting group and 25% in the bypass group. Median time for re-intervention was 9.5 months in angioplasty patients and 36 months in bypass patients (p = 0.102). Target lesion revascularisation was 20.0% for angioplasty procedures, 16.67% for angioplasty and stenting and 25% for bypass procedures.


CONCLUSIONS
Angioplasty with stenting provides improved symptom-free survival and freedom from re-intervention in patients with symptomatic subclavian artery stenosis.
Department of Vascular and Endovascular Surgery, Galway University Hospital, Newcastle Road, Galway, Republic of Ireland.
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C
Byrne
Department of Vascular and Endovascular Surgery, Galway University Hospital, Newcastle Road, Galway, Republic of Ireland.
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W
Tawfick
Department of Vascular and Endovascular Surgery, Galway University Hospital, Newcastle Road, Galway, Republic of Ireland Department of Vascular Surgery, Galway Clinic, Doughiska, Galway, Republic of Ireland.
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Hynes
Department of Vascular and Endovascular Surgery, Galway University Hospital, Newcastle Road, Galway, Republic of Ireland Department of Vascular Surgery, Galway Clinic, Doughiska, Galway, Republic of Ireland sherif.sultan@hse.ie.
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S
Sultan
D000328:Adult; D000368:Aged; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012039:Regional Blood Flow; D019233:Retreatment; D012307:Risk Factors; D015607:Stents; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013349:Subclavian Steal Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014680:Veins / Q000637:transplantation*
Upper limb ischaemia; subclavian angioplasty; subclavian stenosis; subclavian stenting; upper limb bypass