Author/Editor     Takach, Thomas J; Duncan, J Michael; Livesay, James J; Krajcer, Zvonimir; Cervera, Roberto D; Gregorič, Igor D; Ott, David A; Frazier, OH; Reul, George J; Cooley, Denton A
Title     Brachiocephalic reconstruction II: operative and endovascular management of single-vessel disease
Type     članek
Source     J Vasc Surg
Vol. and No.     Letnik 42, št. 1
Publication year     2005
Volume     str. 55-61
Language     eng
Abstract     Objective: Although the surgical management of brachiocephalic disease is well established, evolving endovascular techniques present new options for treatment. We explored the potential benefits and drawbacks of these interventions in terms of outcome. Methods: From 1966 to 2004, 391 consecutive patients (43.7% male; mean age, 61.9 years) with single-vessel brachiocephalic disease were treated with either operative bypass (group A; n = 229) or percutaneous transluminal angioplasty and stenting (group B; n = 162). Results: All patients were asymptomatic after surgery or endovascular intervention. Group A and group B had similar operative mortality (0.9% vs 0.6%) and stroke (1.3% vs 0%) rates. However, 5 years after the procedure, group A had significantly better freedom from graft or intervention failure (92.7% +/- 2.1%) than did group B (83.9% +/- 3.7%; P = .03, Kaplan-Meier analysis; P = .001, Cox regression analysis). At 10 years, group A had the following rates of actuarial freedom from specific events: death, 73.7% +/- 4.6%; myocardial infarction, 84.2% +/- 3.6%; stroke, 91.4% +/- 3.4%; graft failure, 88.1% +/- 3.3%; coronary revascularization, 69.8% +/- 5.1%; and other vascular operation, 70.7% +/- 4.6%. Endovascular intervention involved less initial cost (mean savings, $8787 per procedure), was less invasive, and did not necessitate general anesthesia. On satisfaction questionnaires, 96.5% of patients receiving an endovascular intervention and 95.1% of patients receiving operative bypass for single-vessel brachiocephalic disease subjectively rated their treatment as "good" or "very good." Conclusions: Operative bypass and endovascular intervention for single-vessel brachiocephalic disease are both associated with acceptably low operative morbidity and mortality. (Abstract truncated at 2000 characters)
Descriptors     ANGIOPLASTY, BALLOON
ADULT
AGED
AGED, 80 AND OVER
BRACHIOCEPHALIC VEINS
LIFE TABLES
STENTS
TREATMENT OUTCOME
VASCULAR PATENCY