ORIGINAL ARTICLES   

International Angiology 2002 June;21(2):138-44

Copyright © 2003 EDIZIONI MINERVA MEDICA

language: English

Subclavian carotid transposition for symptomatic subclavian artery stenosis or occlusion. A comparison with the endovascular procedure

Ballotta E., Da Giau G., Abbruzzese E. *, Mion E., Manara R. **, Baracchini C. **

Service of Vascular Surgery and * 1st Medical Clinic of the Department of Medical and Surgical Sciences, and ** Department of Neurologic Sciences University of Padua, School of Medicine, Padua, Italy

Background. Although sub­cla­vian-carot­id trans­po­si­tion (SCT), among all extrath­o­rac­ic revas­cu­lar­iza­tion pro­ce­dures, has ­emerged as the treat­ment of ­choice for symp­to­mat­ic sub­cla­vian ­artery (SA) sten­o­sis or occlu­sion, some ­authors advo­cate per­cut­ane­ous trans­lu­mi­nal angio­plas­ty with stent­ing as the opti­mum pri­mary ther­a­py. Aim: to ­assess safe­ty, effi­ca­cy and dur­abil­ity of SCT in the treat­ment of symp­to­mat­ic SA sten­o­sis or occlu­sion.
Methods. Design: ­review of a pros­pec­tive­ly main­tained vas­cu­lar sur­gi­cal reg­is­try. Setting: University vas­cu­lar sur­gi­cal ser­vice. Patients: 39 ­patients requir­ing sur­gery for symp­to­mat­ic sten­o­sis or occlu­sion of the prox­i­mal SA from September 1985 to August 1999. Intervention: SCT. Measures: data were col­lect­ed pros­pec­tive­ly from hos­pi­tal ­charts and ­office med­i­cal ­records to deter­mine dem­o­graph­ics, risk fac­tors, pre­sent­ing clin­i­cal man­i­fes­ta­tion, blood pres­sure dif­fe­ren­tials, loca­tion of the SA ­lesion and early post­op­er­a­tive out­come. Long-term fol­low-up was available in all ­patients. Patency of the revas­cu­lar­iza­tion was deter­mined by phys­i­cal exam­ina­tion and non-inva­sive labor­a­to­ry stud­ies.
Results. The per­i­op­er­a­tive mor­tal­ity and mor­bid­ity rates were 2.5% (1 of 39) and 2.5% (1 of 39), respec­tive­ly. Immediate ­relief of symp­toms was ­achieved in 100% of cases. Mean fol­low-up was 6.8 years. Revascularization nei­ther ­failed dur­ing the fol­low-up peri­od, nor did ­patients have recur­rent symp­toms. The over­all sur­vi­val rates at 1, 3, 5 and 10 years were 100%, 100%, 86% and 68%. Overall late mor­tal­ity rate was 18.4%: no death was ­stroke relat­ed.
Conclusions. SCT is a very safe and effec­tive sur­gi­cal pro­ce­dure for the treat­ment of symp­to­mat­ic SA ath­e­ros­cle­rot­ic dis­ease, ensuring an excel­lent long-term paten­cy.