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Concomitant subclavian and carotid artery disease: the need for a combined surgical correction
A Mingoli1, R J Feldhaus, C Farina
1Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska.
Insights
Treating carotid artery disease alongside subclavian artery revascularization for subclavian steal syndrome significantly reduces neurological events. Combined correction of both carotid and subclavian lesions is recommended for optimal patient outcomes.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiovascular Disease
Background:
- Subclavian steal syndrome (SSS) can be associated with concomitant carotid artery disease.
- The impact of untreated carotid lesions in SSS patients undergoing subclavian revascularization is not fully understood.
Purpose of the Study:
- To evaluate the significance of carotid artery disease in patients undergoing proximal subclavian artery revascularization for SSS.
- To determine the outcomes of combined versus staged surgical correction of SSS and carotid lesions.
Main Methods:
- Retrospective review of 55 patients with SSS undergoing subclavian artery revascularization over 18 years.
- Patients were categorized based on the presence (Group I) or absence (Group II) of significant carotid artery disease (>50% stenosis).
- Group I was further divided into those treated with carotid endarterectomy (CEA) (Group IA) and those with untreated carotid lesions (Group IB).
Main Results:
- Concomitant carotid artery disease was present in 63.6% of patients (Group I).
- The 5-year freedom rate from neurological events was significantly higher in Group IA (87.2%) and Group II (100%) compared to Group IB (34.9%).
- Untreated carotid lesions negatively impacted early and late functional results after subclavian artery reconstruction.
Conclusions:
- The presence of hemodynamically significant carotid artery disease is common in patients with SSS.
- Combined surgical correction of both subclavian and carotid artery lesions should be recommended in all such patients.
- Addressing carotid lesions concurrently with subclavian revascularization improves neurological outcomes.
Abstract:
To determine the importance of carotid artery disease in patients undergoing revascularization of the proximal subclavian artery for a subclavian steal syndrome, an 18-year experience of 55 patients was reviewed. Concomitant carotid artery disease (> 50% stenosis) was present in 35 patients (Group I: 63.6%). Twenty patients (Group II: 36.4%) had no evidence of hemodynamically significant carotid disease. Twenty-five patients in Group I (Group IA: 71.4%) were treated by endarterectomy (CEA) for all their carotid lesions while one or both carotid lesions were left untreated in 10 patients (Group IB: 28.6%). The actuarial 5-year freedom rate from neurological events was 87.2% in Group IA, 34.9% in Group IB (p < 0.001) and 100% in Group II (Group IB vs. II, p < 0.001; Group IA vs. Group II, p = ns). All untreated carotid lesions had a deleterious effect on the early and late functional results after surgical reconstruction of the subclavian artery. We conclude that the combined correction of subclavian and carotid lesions should be recommended in every case.