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.
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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)
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Chemical References |
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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
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