Open operations or endovascular interventions in lesions of the first segment of the subclavian artery?

Gavrilenko A.V.^1,2, Ivanov V.A.³, Kuklin A.V.¹, Al-Yusef N.N.^1,2

1) Department of Vascular Surgery, Russian Research Centre of Surgery named after Academician B.V. Petrovsky under the Russian Academy of Medical Sciences,
2) Chair of Cardiovascular Surgery No1 of the Institute of Professional Education, First Moscow State Medical University named after I.M. Sechenov, Moscow, Russia
3) Centre of Endovascular Surgery, 3rd Central Military Clinical Hospital named after A.A. Vishnevsky under the Ministry of Defence of the Russian Federation, city of Krasnogorsk, Russia

Materials and methods. The study included a total of 110 patients presenting with stenoses of the first portion of the subclavian artery (SCA). Group One comprised 55 (50%) patients subjected to carotid-subclavian bypass grafting. The degree of stenosis varied from 65 to 95% (p>0.05), occlusion of the SCA was found in 28 (p<0.05) patients, permanent steal syndrome was observed in 39 (p>0.05) patients. Concomitant cardiac pathology was observed in 30 (55%) patients, with one (2%) patient having a history of stroke. Group Two was composed of 55 (50%) patients undergoing endovascular interventions. The degree of stenosis varied from 65 to 95%, with eight patients having occlusion of the SCA. Permanent steal syndrome was observed in 36 patients. Accompanying cardiac pathology was noted in 28 (51%) patients, with eight (15%) patients having a history of stroke (p<0.05).

Results. In Group One, six months after surgery, of 41 cases thrombosis was revealed in 2 patients. 2 years later, of 36 cases, thrombosis was detected in 7 patients. After 5 years, of 19 cases, thrombosis was revealed in 6. After more than 5 years, of 11 cases thrombosis was revealed in 6. In Group Two 6 months after surgery, of 46 cases, the stent ceased to function in 8 patients. After 2 years, of 41 cases, 21 were found to have developed thrombosis. After 5 years – of 20 cases, thrombosis was revealed in 16. Of 7 cases after more than 5 years the stent failed to function in 6.

Conclusion. The operation of carotid-subclavian bypass grafting turned out more effective in the remote postoperative period.

KEY WORDS: subclavian artery, steal syndrome, carotid-subclavian bypass grafting, stenting of the subclavian artery, remote results.

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