Subclavian carotid transposition for symptomatic subclavian artery stenosis or occlusion. A comparison with the endovascular procedure.
BACKGROUND: Although subclavian-carotid transposition (SCT), among all extrathoracic revascularization procedures, has emerged as the treatment of choice for symptomatic subclavian artery (SA) stenosis or occlusion, some authors advocate percutaneous transluminal angioplasty with stenting as the optimum primary therapy. AIM: to assess safety, efficacy and durability of SCT in the treatment of symptomatic SA stenosis or occlusion. METHODS DESIGN: review of a prospectively maintained vascular surgical registry. SETTING: University vascular surgical service. PATIENTS: 39 patients requiring surgery for symptomatic stenosis or occlusion of the proximal SA from September 1985 to August 1999. INTERVENTION: SCT. MEASURES: data were collected prospectively from hospital charts and office medical records to determine demographics, risk factors, presenting clinical manifestation, blood pressure differentials, location of the SA lesion and early postoperative outcome. Long-term follow-up was available in all patients. Patency of the revascularization was determined by physical examination and non-invasive laboratory studies. RESULTS: The perioperative mortality and morbidity rates were 2.5% (1 of 39) and 2.5% (1 of 39), respectively. Immediate relief of symptoms was achieved in 100% of cases. Mean follow-up was 6.8 years. Revascularization neither failed during the follow-up period, nor did patients have recurrent symptoms. The overall survival rates at 1, 3, 5 and 10 years were 100%, 100%, 86% and 68%. Overall late mortality rate was 18.4%: no death was stroke related. CONCLUSIONS: SCT is a very safe and effective surgical procedure for the treatment of symptomatic SA atherosclerotic disease, ensuring an excellent long-term patency.