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Endovascular stenting for stenoses in surgically reconstructed brachiocephalic bypass grafts: immediate and midterm
Angelo Anzuini1, Roberto Chiesa, Krishnamoorthy Vivekananthan
1University of Texas Medical Branch, Galveston, USA.
Purpose:
To report the use of endovascular stenting for treatment of patients with symptomatic obstruction of brachiocephalic surgical reconstructions.
Methods:
Twenty-two patients (17 men; mean age 65+/-6 years) with 24 symptomatic obstructions of brachiocephalic Dacron bypass grafts (2 aorto-innominate, 9 subclavian-carotid, and 11 carotid-subclavian) were treated with balloon-expandable stents delivered via a percutaneous brachial access or surgical exposure of the common carotid artery. A distal protection device was utilized in the 9 patients with subclavian-carotid bypass grafts. All patients were followed by clinical and Doppler examinations.
Results:
Procedural success was 100%; 1 (4.5%) patient developed transient intraprocedural aphasia owing to intolerance to the distal protection balloon occlusion. All 22 patients reported complete relief of their presenting symptoms. Over a 29-month follow-up, 3 (13.6%) restenoses were found, but none was due to stent compression.
Conclusions:
Stenting for obstructed brachiocephalic reconstructions appears to be a safe, effective, and durable therapeutic strategy.