PMID- 18411028
OWN - NLM
STAT- MEDLINE
DCOM- 20080626
LR  - 20080509
IS  - 1615-5947 (Electronic)
IS  - 0890-5096 (Linking)
VI  - 22
IP  - 3
DP  - 2008 May-Jun
TI  - Outcomes of endoluminal therapy for ostial disease of the major branches of the 
      aortic arch.
PG  - 388-94
LID - 10.1016/j.avsg.2007.07.040 [doi]
AB  - While aggressive endoluminal therapy for occlusive disease of the major branches 
      of the arch of the aorta (brachiocephalic [BCA], left common carotid [LCCA], and 
      left subclavian [LSCA] arteries) is commonplace, long-term outcomes in this 
      population are unclear. We examined the long-term outcomes of endoluminal therapy 
      for ostial aortic arch disease at a single tertiary referral academic medical 
      center. A prospective database of patients undergoing endovascular treatment of 
      aortic arch vessel atherosclerotic occlusive disease between 1990 and 2004 was 
      maintained and retrospectively analyzed. Patients with stenotic ostial lesions of 
      the major thoracic aorta branches were selected. Angiograms were reviewed in all 
      cases to assess lesion characteristics. Patency was assessed by routine clinical 
      and, in the LCCA and LSCA, duplex ultrasound follow-up at 1, 6, and 12 months 
      postintervention and every 12 months thereafter. Results were standardized to 
      current Trans-Atlantic Inter-Society Consensus and Society for Vascular Surgery 
      criteria. Kaplan-Meier analyses were performed to assess time-dependent outcomes. 
      Factor analyses were performed using a Cox proportional hazard model for 
      time-dependent variables. Data are presented as mean +/- SEM. Forty-four patients 
      (average age 64 +/- 2 years, 59% male) underwent 26 LSCA, 11 LCCA, and eight BCA 
      interventions for primary indications of arm ischemia (29%), prevention or 
      treatment of coronary steal syndrome (29%), or cerebrovascular signs/symptoms 
      (42%). The technical success rate was 98%, with a 90-day mortality rate of 0% and 
      a major adverse event rate of 2%. There were no strokes and no upper extremity 
      embolic events. Cumulative patency was 88 +/- 8% at 3 years, with a 
      reintervention rate of 7%. The overall symptom recurrence rate was 4%. No local 
      or systemic factors were associated with poor outcomes. Endoluminal stenting for 
      ostial disease of the branches of the aortic arch provides excellent and 
      long-term patency rates with low morbidity, mortality, and secondary intervention 
      rates. With an overall technical success of 98%, our results parallel those for 
      lesions located more distally in the arch branches and support the continued use 
      of percutaneous therapy for atherosclerotic disease throughout the arch branches.
FAU - Bakken, Andrew M
AU  - Bakken AM
AD  - Department of Surgery, Center for Vascular Disease, University of Rochester, 
      Rochester, NY 14642, USA.
FAU - Palchik, Eugene
AU  - Palchik E
FAU - Saad, Wael E
AU  - Saad WE
FAU - Hart, Joseph P
AU  - Hart JP
FAU - Singh, Michael J
AU  - Singh MJ
FAU - Rhodes, Jeffrey M
AU  - Rhodes JM
FAU - Waldman, David L
AU  - Waldman DL
FAU - Davies, Mark G
AU  - Davies MG
LA  - eng
PT  - Journal Article
DEP - 20080414
PL  - Netherlands
TA  - Ann Vasc Surg
JT  - Annals of vascular surgery
JID - 8703941
SB  - IM
MH  - Aged
MH  - Arm/blood supply
MH  - Atherosclerosis/complications/pathology/physiopathology/*surgery
MH  - Blood Vessel Prosthesis Implantation/adverse effects/*instrumentation
MH  - Brachiocephalic Trunk/pathology/physiopathology/*surgery
MH  - Carotid Artery, Common/pathology/physiopathology/*surgery
MH  - Cerebrovascular Disorders/etiology/surgery
MH  - Constriction, Pathologic
MH  - Female
MH  - Humans
MH  - Ischemia/etiology/surgery
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Severity of Illness Index
MH  - *Stents
MH  - Subclavian Artery/pathology/physiopathology/*surgery
MH  - Time Factors
MH  - Treatment Outcome
MH  - Ultrasonography, Doppler, Duplex
MH  - Vascular Patency
EDAT- 2008/04/16 09:00
MHDA- 2008/06/27 09:00
CRDT- 2008/04/16 09:00
PHST- 2007/03/20 00:00 [received]
PHST- 2007/07/08 00:00 [revised]
PHST- 2007/07/18 00:00 [accepted]
PHST- 2008/04/16 09:00 [pubmed]
PHST- 2008/06/27 09:00 [medline]
PHST- 2008/04/16 09:00 [entrez]
AID - S0890-5096(08)00042-3 [pii]
AID - 10.1016/j.avsg.2007.07.040 [doi]
PST - ppublish
SO  - Ann Vasc Surg. 2008 May-Jun;22(3):388-94. doi: 10.1016/j.avsg.2007.07.040. Epub 
      2008 Apr 14.