Endovascular and Surgical Management of Subclavian Artery Occlusive Disease: Early and Long-Term Outcomes

Abstract

The aim of the study was to report early and late outcomes of surgical and endovascular management of subclavian artery atherosclerotic disease (SAAD). Data about consecutive patients treated for subclavian artery atherosclerotic occlusive disease between 2001 and 2018 either by open surgical repair (OSR) or by endovascular repair (ER) were retrospectively collected and analyzed. Primary outcomes included 30-day death, as well as cardiac and neurologic events, reported separately for occlusion and stenosis. Secondary outcomes included primary patency in the long term, reported separately for occlusive and stenotic lesions. The Kaplan-Meier analysis with the logrank test was used to estimate long-term primary patency. Chi-squared and t-tests were used as appropriate to compare the outcomes of the 2 groups. A P value<0.05 was considered statistically significant. Sixty-eight patients were treated using ER (49 patients) and OSR (19). Technical success rate was 100% in both groups. During in-hospital stay, 1 brachial hematoma and 2 acute upper limb ischemia occurred in the ER group and in the OSR group, respectively. At 30days, no deaths or neurological/cardiac events were recorded in both ER and OSR groups. Symptoms resolution and upper limb salvage were 100% in both groups. In the ER group, primary patency was 100% at 7years in patients who had been treated for stenotic lesions and 62.5±21.3% in patients who had been treated for occlusive lesions (P=0.0035). In the OSR group, primary patency was 100% at 7years in patients treated for stenotic lesions and 25±21.6% in patients who had been treated for occlusive lesions (P<0.0001). Overall, long-term primary patency in the OSR group was 76.9±11.7% at 7years, being lower than that reported after ER (93.4±4.5%, P=0.02). Both ER and OSR proved to be safe, effective, and durable in the treatment of SAAD. In particular, the primary patency rates at long term for both ER and OSR showed better outcomes for stenotic lesions.