title: Outcomes of the Endovascular Treatment for the Supra-Aortic Trunks Occlusive Disease: A 14-Year Monocentric Experience.
abstract: BACKGROUND
  Endovascular treatment of proximal supra-aortic trunks (SAT) has become a safe and reliable alternative to conventional open surgery, with a lower morbimortality rate and good short- and middle-term patency rates. The aim of our study was to assess the long-term results of endovascular treatment of proximal lesions of the SAT (brachiocephalic trunk, common carotid artery, and subclavian artery) and identify predictive risk factors of restenosis.
  
  
  METHODS
  From 1999 to 2013, 67 consecutive stenotic lesions of the proximal SAT were treated by angioplasty (13.4%) or stenting (86.6%) in 63 patients with a mean age of 65.5 years (40-87). Procedures were performed under general (69%), local (24%), or locoregional (7%) anesthesia, with percutaneous puncture (47.8%) or open access (52.2%). Patients were followed up for 3, 6, and 12 months, and then every year with clinical examination, Doppler ultrasound and if required an angio-CT scan.
  
  
  RESULTS
  The technical success rate was 98.5%. There was no postoperative death or strokes. One myocardial infarction occurred at day 2. There were 2 access complications: a nonsurgical hematoma after brachial access and a brachial thrombosis postpuncture. The mean follow-up was 4.5 years (2-163 months). The primary- and assisted-patency rates were 90.1%, 86.4%, 77.9% and 93.3%, 91.4%, 82.9% at 1, 2, and 5 years, respectively. Eleven restenosis (16.4%) occurred at 28.5 months (3, 0-112, 0) of follow-up. Four of them required an endovascular repair and 3 required a surgical one. The restenosis rate was 17.5% in the stented group on average at 30.2 months of follow-up (range, 3.0-112.0) and 10% in the group of patients with angioplasty alone at 8 months of follow-up, without significant statistically difference (P = 0.9). No predictive risk factor of restenosis was statistically identified.
  
  
  CONCLUSIONS
  The endovascular treatment of proximal stenosis of SAT is a safe, reliable, and efficient technique with a low morbidity and mortality. The long-term results are good, but restenosis can occur. Long-term follow-up should be performed to detect and treat restenosis.
authors.affiliation: Department of Vascular Surgery, CHU Clermont-Ferrand, Clermont-Ferrand, France; Groupe de Recherche sur la Thrombose, Saint-Etienne, France.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Ben Ahmed
authors.affiliation: Department of Vascular Surgery, CHU Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Benezit
authors.affiliation: Department of Public Health, CHU Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: Juliette
authors.initials: J
authors.lastname: Hazart
authors.affiliation: Department of Vascular Surgery, CHU Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: Anthony
authors.initials: A
authors.lastname: Brouat
authors.affiliation: Department of Vascular Surgery, CHU Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Daniel
authors.affiliation: Department of Vascular Surgery, CHU Clermont-Ferrand, Clermont-Ferrand, France; Groupe de Recherche sur la Thrombose, Saint-Etienne, France; Clermont Université, Université Clermont1, Faculté de Médecine, Clermont-Ferrand, France. Electronic address: erosset@chu-clermontferrand.fr.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Rosset
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D016122:Brachiocephalic Trunk / Q000000981:diagnostic imaging / Q000503:physiopathology; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D000072226:Computed Tomography Angiography; D003251:Constriction, Pathologic; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D005602:France; D006406:Hematoma / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D011677:Punctures; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014654:Vascular Patency