Endovascular stenting vs. extrathoracic surgical bypass for symptomatic subclavian steal syndrome.

Abstract

PURPOSE:

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).

CONCLUSION:

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.

• Authors: Lipo Song, Jian Zhang, Jianxin Li, Yongquan Gu, Hengxi Yu, Bing Chen, Lianrui Guo, Zhonggao Wang
• Journal: Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists (J Endovasc Ther) Vol. 19 Issue 1 Pg. 44-51 (Feb 2012) ISSN: 1545-1550 [Electronic] United States
• PMID: 22313201 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Polytetrafluoroethylene

Topics

• Aged
• Blood Vessel Prosthesis
• Blood Vessel Prosthesis Implantation (adverse effects, instrumentation, mortality)
• China
• Endovascular Procedures (adverse effects, instrumentation, mortality)
• Female
• Humans
• Male
• Middle Aged
• Multivariate Analysis
• Patient Selection
• Polytetrafluoroethylene
• Proportional Hazards Models
• Prosthesis Design
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Stents
• Subclavian Steal Syndrome (complications, mortality, physiopathology, surgery, therapy)
• Survival Analysis
• Time Factors
• Treatment Outcome
• Vascular Patency