| Brachiocephalic reconstruction II: operative and endovascular management of single-vessel disease. | |
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MedLine Citation:
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PMID: 16012452 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. Operative bypass produces significantly better mid-term freedom from graft or intervention failure than endovascular intervention and produces excellent long-term freedom from failure. Endovascular intervention offers tangible benefits regarding cost, level of invasiveness, and subjective patient satisfaction. Undetermined are the differences between the procedures regarding long-term durability, patterns of failure, efficacy as an adjunct to coronary artery bypass grafting, need for anticoagulation, efficacy as treatment for complex (multivessel) disease, and long-term cost. |
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Authors:
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Thomas J Takach; J Michael Duncan; James J Livesay; Zvonimir Krajcer; Roberto D Cervera; Igor D Gregoric; David A Ott; O H Frazier; George J Reul; Denton A Cooley |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of vascular surgery Volume: 42 ISSN: 0741-5214 ISO Abbreviation: J. Vasc. Surg. Publication Date: 2005 Jul |
Date Detail:
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Created Date: 2005-07-13 Completed Date: 2005-08-04 Revised Date: 2012-10-03 |
Medline Journal Info:
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Nlm Unique ID: 8407742 Medline TA: J Vasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 55-61 Citation Subset: IM |
Affiliation:
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Department of Cardiovascular Surgery, Texas Heart Institute, Houston, 77225, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Angioplasty, Balloon* Brachiocephalic Veins Female Humans Life Tables Middle Aged Reconstructive Surgical Procedures Stents Treatment Outcome Vascular Patency Vascular Surgical Procedures* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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