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Intra-operative transluminal angioplasty of the supra-aortic vessels
R Karnik1, H P Ammerer, A Valentin
1Second Department of Medicine, Krankenanstalt Rudolfstiftung, Wien, Austria.
Insights
Intra-operative angioplasty successfully treated difficult supra-aortic vessel lesions in most patients. While subclavian artery occlusions recurred, stenoses in carotid and brachiocephalic vessels showed promising long-term patency.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Radiology
Background:
- Supra-aortic vessels are critical for blood supply to the head and arms.
- Surgically inaccessible lesions in these vessels pose significant treatment challenges.
- Intra-operative angioplasty offers a potential minimally invasive approach.
Purpose of the Study:
- To evaluate the efficacy and safety of intra-operative transluminal angioplasty.
- To assess treatment outcomes for difficult or inoperable supra-aortic vessel lesions.
- To determine the suitability of angioplasty for various types of supra-aortic vessel pathology.
Main Methods:
- Nine patients with surgically challenging supra-aortic vessel lesions underwent intra-operative angioplasty.
- Lesions included proximal left subclavian artery occlusions and severe stenoses of carotid, brachiocephalic, and vertebral arteries.
- Angioplasty was performed during surgery for these complex vascular conditions.
Main Results:
- Primary technical success was achieved in all nine patients.
- Two patients with subclavian artery occlusions experienced re-occlusion within days.
- Six of seven patients with stenotic lesions remained symptom-free with no restenosis; one prosthetic graft occlusion occurred at 8 weeks.
Conclusions:
- Intra-operative angioplasty is a valuable alternative for selected surgically inaccessible supra-aortic vessel lesions.
- Angioplasty demonstrates high success rates for stenotic lesions, offering durable results.
- Further investigation is warranted for occlusive lesions, particularly in the subclavian artery.
Abstract:
Intra-operative transluminal angioplasty of supra-aortic vessels was performed in 9 patients. All subjects had lesions which were considered difficult or impossible to operate upon. In 2 patients a proximal occlusion of the left subclavian artery was dilated. Seven subjects showed severe stenoses of the supra-aortic vessels: common carotid artery: 1, internal carotid artery: 2, external carotid artery: 1, external carotid artery prosthetic graft: 1, brachiocephalic trunk: 1, vertebral artery: 1. All patients suffered from symptoms which corresponded to the site of the lesions in question. Intra-operative angioplasty was primarily successful in all 9 patients. Re-occlusion occurred within a few days in both patients who underwent angioplasty of the subclavian artery. Six of the seven subjects with stenotic lesions remained free of symptoms and of restenosis. In the case of dilatation of a prosthetic graft of the external carotid artery asymptomatic occlusion developed within 8 weeks. In selected cases intra-operative angioplasty is a potentially valuable alternative in the treatment of surgically inaccessible lesions of the supra-aortic vessels.