Faculty Collaboration Database

Outcomes of endoluminal therapy for ostial disease of the major branches of the aortic arch. Ann Vasc Surg 2008;22(3):388-94

Date

04/16/2008

Pubmed ID

18411028

DOI

10.1016/j.avsg.2007.07.040

Scopus ID

2-s2.0-42749097795 (requires institutional sign-in at Scopus site)   18 Citations

Abstract

While aggressive endoluminal therapy for occlusive disease of the major branches of the arch of the aorta (brachiocephalic [BCA], left common carotid [LCCA], and left subclavian [LSCA] arteries) is commonplace, long-term outcomes in this population are unclear. We examined the long-term outcomes of endoluminal therapy for ostial aortic arch disease at a single tertiary referral academic medical center. A prospective database of patients undergoing endovascular treatment of aortic arch vessel atherosclerotic occlusive disease between 1990 and 2004 was maintained and retrospectively analyzed. Patients with stenotic ostial lesions of the major thoracic aorta branches were selected. Angiograms were reviewed in all cases to assess lesion characteristics. Patency was assessed by routine clinical and, in the LCCA and LSCA, duplex ultrasound follow-up at 1, 6, and 12 months postintervention and every 12 months thereafter. Results were standardized to current Trans-Atlantic Inter-Society Consensus and Society for Vascular Surgery criteria. Kaplan-Meier analyses were performed to assess time-dependent outcomes. Factor analyses were performed using a Cox proportional hazard model for time-dependent variables. Data are presented as mean +/- SEM. Forty-four patients (average age 64 +/- 2 years, 59% male) underwent 26 LSCA, 11 LCCA, and eight BCA interventions for primary indications of arm ischemia (29%), prevention or treatment of coronary steal syndrome (29%), or cerebrovascular signs/symptoms (42%). The technical success rate was 98%, with a 90-day mortality rate of 0% and a major adverse event rate of 2%. There were no strokes and no upper extremity embolic events. Cumulative patency was 88 +/- 8% at 3 years, with a reintervention rate of 7%. The overall symptom recurrence rate was 4%. No local or systemic factors were associated with poor outcomes. Endoluminal stenting for ostial disease of the branches of the aortic arch provides excellent and long-term patency rates with low morbidity, mortality, and secondary intervention rates. With an overall technical success of 98%, our results parallel those for lesions located more distally in the arch branches and support the continued use of percutaneous therapy for atherosclerotic disease throughout the arch branches.

Author List

Bakken AM, Palchik E, Saad WE, Hart JP, Singh MJ, Rhodes JM, Waldman DL, Davies MG

Author

Joseph Hart MD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Arm
Atherosclerosis
Blood Vessel Prosthesis Implantation
Brachiocephalic Trunk
Carotid Artery, Common
Cerebrovascular Disorders
Constriction, Pathologic
Female
Humans
Ischemia
Male
Middle Aged
Retrospective Studies
Severity of Illness Index
Stents
Subclavian Artery
Time Factors
Treatment Outcome
Ultrasonography, Doppler, Duplex
Vascular Patency