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Percutaneous transluminal angioplasty of the brachiocephalic vessels: guidelines for therapy
1Midwest Vascular Institute, Downers Grove, Illinois.
Insights
Percutaneous transluminal angioplasty (PTA) successfully treated 93% of brachiocephalic vessel lesions. PTA is superior to surgery for five specific lesion types, with a low complication rate.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiovascular Medicine
Background:
- Percutaneous transluminal angioplasty (PTA) is used for brachiocephalic vessel stenoses/occlusions.
- Guidelines for PTA versus surgical intervention are not well-defined.
- Lesion characteristics like pathology and location influence treatment outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of PTA for brachiocephalic vessel lesions.
- To compare PTA outcomes with surgical intervention.
- To define specific lesion types where PTA is superior.
Main Methods:
- Retrospective analysis of 131 brachiocephalic vessel PTA procedures.
- Inclusion of various vessel types: subclavian, axillary, brachial, vertebral, innominate, and carotid arteries.
- Assessment of success rates based on lesion severity, pathology, and location.
Main Results:
- Successful dilation in 93% (122/131) of treated lesions.
- Higher success rates for stenotic lesions (98%) compared to occlusions (40%).
- Low complication rate (2/131), with full recovery in both cases; 5-year follow-up showed 5 restenoses.
Conclusions:
- PTA is a safe and effective treatment for brachiocephalic vessel stenoses/occlusions.
- PTA demonstrates superior outcomes over surgery for five defined lesion types.
- Further research is needed to refine guidelines for PTA versus surgical intervention.
Abstract:
Angioplasty of the brachiocephalic vessels has been utilized in the treatment of stenotic/occlusive lesions for the past twelve years. The guidelines for use of PTA therapy versus surgery, however, have not been well defined. Multiple pathologies and morphologies for the various lesions have been described. The location of the lesion on the brachiocephalic chain plays a role. In our study of 131 brachiocephalic vessels (66 subclavian, 3 axillary, 3 brachial, 35 vertebral, 9 innominate, 6 common carotid, 7 internal carotid and 2 external carotid), we successfully dilated 93% (122/131) of all vessel stenoses/occlusions. Our success rate varied, however, with the severity, pathology, and location of the lesion. [We experienced greater success with stenotic versus occlusions (98%, 118/121 for stenotic lesions, versus 40%, 4/10 for total occlusions)]. In addition, we experienced only 2 complications in our series, a thromboembolism to the arm, and one patient with temporary bilateral blindness. Both patients experienced full recovery. Following PTA therapy, a 5 year follow-up was attempted. Although not complete, we have documented only 5 patients with restenoses at the site of original angioplasty. The restenoses occurred at 3, 6, 8, 12, and 18 months post procedure. Two of the long-term failures were from totally occluded vessels. Through our results, as well as a thorough review of the current literature, we have defined five lesions in which PTA therapy would be superior to surgical intervention.