Technical and Clinical Success and Long-Term Durability of Endovascular Treatment for Atherosclerotic Aortic Arch Branch Origin Obstruction: Evaluation of 144 Procedures

• Published in: European journal of vascular and endovascular surgery Vol. 50; no. 1; pp. 13 - 20
• Main Authors: van de Weijer, M.A.J, Vonken, E.J.P.A, de Vries, J.-P.P.M, Moll, F.L, Vos, J.A, de Borst, G.J
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.07.2015
• Subjects: Adult; Aged; Aorta, Thoracic; Aortic arch; Aortic Diseases - surgery; Atherosclerosis - surgery; Cohort Studies; Endovascular Procedures; Endovascular therapy; Female; Humans; Male; Middle Aged; Origin stenosis or obstruction; Percutaneous transluminal angioplasty; Remission Induction; Retrospective Studies; Stents; Surgery; Time Factors; Treatment Outcome; Percutaneous transluminal angioplasty; Endovascular therapy; Origin stenosis or obstruction; Stents; Aortic arch
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2015.03.058

Objectives Endovascular treatment of atherosclerotic obstruction of aortic arch branch origins (AABO) has largely replaced open surgery, but long-term outcome data are lacking. This study evaluated mid-term and long-term results of these procedures. Design Retrospective cohort study. Materials and methods Patients underwent endovascular treatment for symptomatic atherosclerotic stenosis of AABO between 1995 and 2012. Technical success was defined as uncomplicated revascularization and residual stenosis ≤30%. The primary end point was freedom from restenosis ≥50% on Duplex ultrasonography or magnetic resonance angiography. Secondary end points were freedom from target lesion revascularization or recurrent symptoms. Results 144 lesions were treated in 114 patients (75 female; mean age 66.3 years), by percutaneous transluminal angioplasty (PTA) in 20 patients and PTA and stent in 117 patients (brachiocephalic artery [BCA] 9/54; left common carotid artery [LCCA] 0/7; left subclavian artery [LSA] 11/56). The lesion could not be passed in four patients, and in three patients the intervention was terminated before angioplasty. The 30-day technical success was 94.4%, without deaths or strokes. Mean follow-up was 52.0 months (range 2–163 months). Restenosis-free survival was 95.6%, 92.9%, 87.6%, and 83.2% at 12, 24, 48, and 60 months, respectively. Log-rank test showed no significant difference between PTA only and PTA with additional stent placement at any point ( p  = .375), nor between BCA ( n  = 51), LCCA ( n  = 6), or LSA ( n  = 57). During follow-up, 27 patients (23.7%) became symptomatic (15 BCA, 1 LCCA, and 11 LSA); 19 patients with a restenosis of the target lesion (mean 56.7 months). Symptom-free survival was 94.7%, 92.0%, 82.3%, and 77.9% at 12, 24, 48, and 60 months, respectively. Conclusion Endovascular treatment of aortic arch branch origin obstruction is safe and efficacious in experienced hands and can be considered as the preferred treatment, with good mid-term durability. Recurrent symptomatic lesions can be treated safely by renewed endovascular means.