Surgical versus endovascular revascularization of subclavian artery arteriosclerotic disease
Marco V Usai1,2, Michel J Bosiers3,4, Theodosios Bisdas3,4
1Department of Vascular Surgery, St. Franziskus Hospital GmbH, Münster, Germany - marcov.usai@hotmail.it.
Insights
Surgical repair of subclavian artery atherosclerotic disease (SAAD) shows superior long-term reintervention-free survival and patency compared to endovascular treatment. Open repair significantly reduces reintervention rates for SAAD patients.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Atherosclerosis Research
Background:
- Subclavian artery atherosclerotic disease (SAAD) can be treated with endovascular or open surgical repair.
- Long-term outcome comparisons between these SAAD treatment strategies are limited.
- This study evaluates the performance of endovascular versus surgical revascularization for SAAD.
Purpose of the Study:
- To compare the long-term outcomes of endovascular treatment and open surgical repair for SAAD.
- To assess reintervention-free survival, patency rates, and overall survival between the two treatment modalities.
- To provide evidence for optimal treatment selection in SAAD management.
Main Methods:
- Retrospective review of patients treated for SAAD between 1998 and 2015 at two institutions.
- Primary outcome: composite endpoint of reintervention-free survival (RFS), including reintervention or death.
- Secondary outcomes: primary patency (PPR), secondary patency (SPR), overall survival, and time to reintervention.
Main Results:
- Surgical repair was performed in 25% of patients, while 75% underwent endovascular therapy.
- Median follow-up was significantly longer for surgical (87 months) versus endovascular (27 months) treatment.
- Surgical treatment demonstrated significantly higher 98-month RFS (95% vs. 54%) and PPR (96% vs. 65%) compared to endovascular therapy.
- Open repair was associated with a significantly reduced reintervention rate (HR: 12.04) and improved patency.
Conclusions:
- Surgical treatment for SAAD is associated with superior long-term patency.
- Open repair significantly reduces the need for reinterventions compared to endovascular approaches for SAAD.
- These findings suggest surgical intervention may be preferred for achieving durable outcomes in SAAD.
Background:
Endovascular treatment offers an alternative, less invasive approach to open repair for subclavian artery atherosclerotic disease (SAAD). However, only few studies compared the outcomes of both strategies in the long run. This study reports on the performance of endovascular and surgical revascularization for SAAD.
Methods:
A retrospective review was conducted on patients treated for SAAD at two institutions between January 1998 and December 2015. Primary outcome of this study was the composite endpoint of reintervention-free survival (RFS) defined as time to reintervention and/or death from any cause. Secondary endpoints included primary patency (PPR) and secondary patency (SPR) rates as well as overall survival and time to reintervention.
Results:
Surgical treatment was the preferred treatment option in 27 (25%) patients, while 83 (75%) patients underwent primary stent therapy. The median follow-up was 87 months (interquartile range [IQR]: 38 to 151) in the surgical group and 27 (IQR: 12 to 59) in the endovascular (P=0.0001). Severe arterial wall calcification was more commonly observed in the surgical arm (P<0.0001), while mild and moderate calcification in the endovascular (P=0.0004 and P=0.014). Vessel occlusion was more frequent among patients treated surgically (100% vs. 34%, P<0.0001). At 98 months RFS was significantly higher after surgical treatment (95% vs. 54%, HR: 8.4, 95% CI: 3.9 to 18.1, P=0.0002). Although overall survival did not differ significantly between the two groups (HR: 4.28, 95% CI: 0.86 to 21.22, P=0.093), open repair was associated with reduced reintervention rate (HR: 12.04, 95% CI: 4.98 to 29.12, P=0.001). The PPR at 98 months following surgical and endovascular therapy amounted to 96% and 65% (HR: 12.87, 95% CI: 5.44 to 30.44, P=0.0008) respectively. No significant difference was observed regarding the SPR between the two groups (100% vs. 95%, P=0.090).
Conclusions:
Surgical treatment was associated in this cohort with increased patency and a significant reduction of reinterventions compared to the endovascular approach.
Related Concept Videos
01:30Coronary Artery Disease I: Introduction
01:30Peripheral Artery Disease I: Introduction
01:26Coronary Artery Disease II: Pathophysiology
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:27Coronary Artery Disease V: Interprofessional Care
01:26Peripheral Artery Disease IV: Nursing Management