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Contemporary outcom...
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Bath, JonathanUniv Missouri, Div Vasc Surg, Columbia, MO 65212 USA.
(författare)
Contemporary outcomes after treatment of aberrant subclavian artery and Kommerell's diverticulum
- Artikel/kapitelEngelska2023
Förlag, utgivningsår, omfång ...
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Elsevier BV,2023
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printrdacarrier
Nummerbeteckningar
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LIBRIS-ID:oai:DiVA.org:uu-509151
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-509151URI
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https://doi.org/10.1016/j.jvs.2023.01.014DOI
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Språk:engelska
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Sammanfattning på:engelska
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Ämneskategori:ref swepub-contenttype
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Ämneskategori:art swepub-publicationtype
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Objective: Aberrant subclavian artery (ASA) and Kommerell's diverticulum (KD) are rare vascular anomalies that may be associated with lifestyle-limiting and life-threatening complications. The aim of this study is to report contemporary outcomes after invasive treatment of ASA/KD using a large international dataset.Methods: Patients who underwent treatment for ASA/KD (2000-2020) were identified through the Vascular Low Frequency Disease Consortium, a multi-institutional collaboration to investigate uncommon vascular disorders. We report the early and mid-term clinical outcomes including stroke and mortality, technical success, and other operative outcomes including reintervention rates, patency, and endoleak.Results: Overall, 285 patients were identified during the study period. The mean patient age was 57 years; 47% were female and 68% presented with symptoms. A right-sided arch was present in 23%. The mean KD diameter was 47.4 mm (range, 13.0-108.0 mm). The most common indication for treatment was symptoms (59%), followed by aneurysm size (38%). The most common symptom reported was dysphagia (44%). A ruptured KD was treated in 4.2% of cases, with a mean diameter of 43.9 mm (range, 18.0-100.0 mm). An open procedure was performed in 101 cases (36%); the most common approach was ASA ligation with subclavian transposition. An endovascular or hybrid approach was performed in 184 patients (64%); the most common approach was thoracic endograft and carotid-subclavian bypass. A staged operative strategy was employed more often than single setting repair (55% vs 45%). Compared with endovascular or hybrid approach, those in the open procedure group were more likely to be younger (49 years vs 61 years; P < .0001), female (64% vs 36%; P < .0001), and symptomatic (85% vs 59%; P < .0001). Complete or partial symptomatic relief at 1 year after intervention was 82.6%. There was no association between modality of treatment and symptom relief (open 87.2% vs endovascular or hybrid approach 78.9%; P = .13). After the intervention, 11 subclavian occlusions (4.5%) occurred; 3 were successfully thrombectomized resulting in a primary and secondary patency of 95% and 96%, respectively, at a median follow-up of 39 months. Among the 33 reinterventions (12%), the majority were performed for endoleak (36%), and more reinterventions occurred in the endovascular or hybrid approach than open procedure group (15% vs 6%; P = .02). The overall survival rate was 87.3% at a median follow-up of 41 months. The 30-day stroke and death rates were 4.2% and 4.9%, respectively. Urgent or emergent presentation was independently associated with increased risk of 30-day mortality (odds ratio [OR], 19.8; 95% confidence interval [CI], 3.3-116.6), overall mortality (OR, 3.6; 95% CI, 1.2-11.2) and intraoperative complications (OR, 8.3; 95% CI, 2.8-25.1). Females had a higher risk of reintervention (OR, 2.6; 95% CI, 1.0-6.5). At an aneurysm size of 44.4 mm, receiver operator characteristic curve analysis suggested that 60% of patients would have symptoms.Conclusions: Treatment of ASA/KD can be performed safely with low rates of mortality, stroke and reintervention and high rates of symptomatic relief, regardless of the repair strategy. Symptomatic and urgent operations were associated with worse outcomes in general, and female gender was associated with a higher likelihood of reintervention. Given the worse overall outcomes when symptomatic and the inherent risk of rupture, consideration of repair at 40 mm is reasonable in most patients. ASA/KD can be repaired in asymptomatic patients with excellent outcomes and young healthy patients may be considered better candidates for open approaches versus endovascular or hybrid modalities, given the lower likelihood of reintervention and lower early mortality rate.
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Biuppslag (personer, institutioner, konferenser, titlar ...)
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D'Oria, MarioUniv Hosp Trieste ASUGI, Cardiovasc Dept, Div Vasc & Endovasc Surg, Trieste, Italy.
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Rogers, Richard T.Mayo Clin, Dept Surg, Div Vasc & Endovasc Surg, Rochester, NY USA.
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Colglazier, Jill J.Mayo Clin, Dept Surg, Div Vasc & Endovasc Surg, Rochester, NY USA.
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Braet, Drew J.Univ Michigan, Dept Surg, Div Vasc Surg, Ann Arbor, MI USA.
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Coleman, Dawn M.Univ Michigan, Dept Surg, Div Vasc Surg, Ann Arbor, MI USA.
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Scali, Salvatore T.Univ Florida, Div Vasc & Endovasc Therapy, Coll Med, Gainesville, FL USA.
(författare)
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Back, Martin R.Univ Florida, Div Vasc & Endovasc Therapy, Coll Med, Gainesville, FL USA.
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Magee, Gregory A.Univ Southern Calif, Dept Surg, Div Vasc & Endovasc Therapy, Los Angeles, CA USA.
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Plotkin, AnastasiaUniv Southern Calif, Dept Surg, Div Vasc & Endovasc Therapy, Los Angeles, CA USA.
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Dueppers, PhilipUniv Hosp Zurich, Dept Vasc Surg, Zurich, Switzerland.;Univ Messina, Dept Med Sci & Morphofunct Imaging, Div Vasc Surg, Messina, Italy.
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Zimmermann, AlexanderUniv Hosp Zurich, Dept Vasc Surg, Zurich, Switzerland.
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Affi, Rana O.UTHealth, Cardiothorac & Vasc Surg, McGovern Med Sch, Houston, TX USA.
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Khan, SophiaUTHealth, Cardiothorac & Vasc Surg, McGovern Med Sch, Houston, TX USA.
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Zarkowsky, DevinUniv Colorado, Dept Surg, Div Vasc Surg, Sch Med, Aurora, CO USA.
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Dyba, GregoryUniv Colorado, Dept Surg, Div Vasc Surg, Sch Med, Aurora, CO USA.
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Soult, Michael C.Loyola Univ Chicago, Stritch Sch Med, Dept Surg, Div Vasc Surg & Endovasc Therapy, Maywood, IL USA.
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Mani, Kevin,1975-Uppsala universitet,Kärlkirurgi(Swepub:uu)kevma940
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Wanhainen, AndersUppsala universitet,Kärlkirurgi(Swepub:uu)anwan103
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Setacci, CarloUniv Siena, Dept Med Surg & Neurosci, Div Vasc & Endovasc Surg, Siena, Italy.
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Lenti, MassimoUniv Siena, Dept Med Surg & Neurosci, Div Vasc & Endovasc Surg, Siena, Italy.
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Kabbani, Loay S.Henry Ford Hosp, Dept Surg, Div Vasc Surg, Detroit, MI USA.
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Weaver, Mitchelle R.Henry Ford Hosp, Dept Surg, Div Vasc Surg, Detroit, MI USA.
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Bissacco, DanieleIRCCS Ca Granda Osped Maggiore Policlin, Dept Vasc Surg, Milan, Italy.
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Trimarchi, SantiIRCCS Ca Granda Osped Maggiore Policlin, Dept Vasc Surg, Milan, Italy.
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Stoecker, Jordan B.Hosp Univ Penn, Div Vasc Surg & Endovasc Therapy, Dept Surg, Philadelphia, PA USA.
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Wang, Grace J.Hosp Univ Penn, Div Vasc Surg & Endovasc Therapy, Dept Surg, Philadelphia, PA USA.
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Szeberin, ZoltanSemmelweis Univ, Dept Vasc & Endovasc Surg, Budapest, Hungary.
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Pomozi, EnikoSemmelweis Univ, Dept Vasc & Endovasc Surg, Budapest, Hungary.
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Moffatt, ClareUniv Calif Los Angeles, Div Vasc & Endovasc Surg, Dept Surg, David Geffen Sch Med, Los Angeles, CA USA.
(författare)
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Gelabert, Hugh A.Univ Calif Los Angeles, Div Vasc & Endovasc Surg, Dept Surg, David Geffen Sch Med, Los Angeles, CA USA.
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Tish, ShahedUniv Missouri, Div Vasc Surg, Columbia, MO 65212 USA.
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Hoel, Andrew W.Northwestern Univ, Dept Surg, Div Vasc Surg, Feinberg Sch Med, Chicago, IL USA.
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Cortolillo, Nicholas S.Northwestern Univ, Dept Surg, Div Vasc Surg, Feinberg Sch Med, Chicago, IL USA.
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Spangler, Emily L.Univ Alabama Birmingham, Dept Surg, Div Vasc Surg & Endovasc Therapy, Birmingham, AL USA.
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Passman, Marc A.Univ Alabama Birmingham, Dept Surg, Div Vasc Surg & Endovasc Therapy, Birmingham, AL USA.
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De Caridi, GiovanniUniv Messina, Dept Med Sci & Morphofunct Imaging, Div Vasc Surg, Messina, Italy.
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Benedetto, Filippo
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Zhou, WeiUniv Arizona, Dept Surg, Div Vasc Surg, Tucson, AZ USA.
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Abuhakmeh, YousefUniv Arizona, Dept Surg, Div Vasc Surg, Tucson, AZ USA.
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Newton, Daniel H.Virginia Commonwealth Univ, Dept Surg, Div Vasc Surg, Sch Med, Richmond, VA USA.
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Liu, Christopher M.Virginia Commonwealth Univ, Dept Surg, Div Vasc Surg, Sch Med, Richmond, VA USA.
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Tinelli, GiovanniUniv Cattolica Sacro Cuore, Fdn Policlin Univ A Gemelli IRCCS, Dept Cardiovasc Sci, Unit Vasc Surg, Rome, Italy.
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Tshomba, YamumeUniv Cattolica Sacro Cuore, Fdn Policlin Univ A Gemelli IRCCS, Dept Cardiovasc Sci, Unit Vasc Surg, Rome, Italy.
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Katoh, AiriUniv Calif San Francisco Fresno, Dept Surg, Fresno, CA USA.
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Siada, Sammy S.Univ Calif San Francisco Fresno, Dept Surg, Fresno, CA USA.
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Khashram, ManarUniv Auckland, Dept Surg, Waikato, New Zealand.
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Gormley, SineadUniv Auckland, Dept Surg, Waikato, New Zealand.
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Mullins, John R.CoxHealth, Dept Surg, Div Vasc Surg, Springfield, MO USA.
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Schmittling, Zachary C.CoxHealth, Dept Surg, Div Vasc Surg, Springfield, MO USA.
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Maldonado, Thomas S.New York Univ Langone Hlth, Dept Surg, Div Vasc Surg, New York, NY USA.
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Politano, Amani D.Oregon Hlth & Sci Univ, Dept Surg, Div Vasc Surg, Portland, OR USA.
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Rynio, PawelPomeranian Med Univ, Dept Vasc Surg, Szczecin, Poland.
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Kazimierczak, ArkadiuszPomeranian Med Univ, Dept Vasc Surg, Szczecin, Poland.
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Gombert, AlexanderUniv Hosp RWTH Aachen, European Vasc Ctr Aachen Maastricht, Dept Vasc Surg, Aachen, Germany.
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Jalaie, HoumanUniv Hosp RWTH Aachen, European Vasc Ctr Aachen Maastricht, Dept Vasc Surg, Aachen, Germany.
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Spath, PaoloUniv Bologna, Dept Vasc Surg, DIMES, Bologna, Italy.
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Gallitto, EnricoUniv Bologna, Dept Vasc Surg, DIMES, Bologna, Italy.
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Czerny, MartinAlbert Ludwigs Univ Freiburg, Univ Heart Ctr Freiburg Bad Krozingen, Univ Clin Freiburg, Clin Cardiovasc Surg, Freiburg, Germany.
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Berger, TimAlbert Ludwigs Univ Freiburg, Univ Heart Ctr Freiburg Bad Krozingen, Univ Clin Freiburg, Clin Cardiovasc Surg, Freiburg, Germany.
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Davies, Mark G.UT Hlth San Antonio, Long Sch Med, Div Vasc & Endovasc Surg, San Antonio, TX USA.
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Stilo, Francesco
(författare)
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Montelione, NunzioUniv Campus Biomed Rome, Dept Med & Surg, Operat Res Unit Vasc Surg, Rome, Italy.
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Mezzetto, LucaIntegrated Univ Hosp Verona, Div Vasc Surg, Verona, Italy.
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Veraldi, Gian FrancoIntegrated Univ Hosp Verona, Div Vasc Surg, Verona, Italy.
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Lepidi, SandroUniv Hosp Trieste ASUGI, Cardiovasc Dept, Div Vasc & Endovasc Surg, Trieste, Italy.
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Lawrence, PeterUniv Calif Los Angeles, Div Vasc & Endovasc Surg, Dept Surg, David Geffen Sch Med, Los Angeles, CA USA.
(författare)
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Woo, KarenUniv Calif Los Angeles, Div Vasc & Endovasc Surg, Dept Surg, David Geffen Sch Med, Los Angeles, CA USA.
(författare)
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Univ Missouri, Div Vasc Surg, Columbia, MO 65212 USA.Univ Hosp Trieste ASUGI, Cardiovasc Dept, Div Vasc & Endovasc Surg, Trieste, Italy.
(creator_code:org_t)
Sammanhörande titlar
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Ingår i:Journal of Vascular Surgery: Elsevier BV77:5, s. 1339-1348.e60741-52141097-6809
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Bath, Jonathan
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D'Oria, Mario
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Rogers, Richard ...
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Colglazier, Jill ...
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Braet, Drew J.
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Coleman, Dawn M.
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visa fler...
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Scali, Salvatore ...
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Back, Martin R.
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Magee, Gregory A ...
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Plotkin, Anastas ...
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Dueppers, Philip
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Zimmermann, Alex ...
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Affi, Rana O.
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Khan, Sophia
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Zarkowsky, Devin
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Dyba, Gregory
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Soult, Michael C ...
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Mani, Kevin, 197 ...
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Wanhainen, Ander ...
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Setacci, Carlo
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Lenti, Massimo
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Kabbani, Loay S.
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Weaver, Mitchell ...
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Bissacco, Daniel ...
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Trimarchi, Santi
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Stoecker, Jordan ...
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Wang, Grace J.
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Szeberin, Zoltan
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Pomozi, Eniko
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Moffatt, Clare
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Gelabert, Hugh A ...
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Tish, Shahed
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Hoel, Andrew W.
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Cortolillo, Nich ...
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Spangler, Emily ...
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Passman, Marc A.
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De Caridi, Giova ...
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Benedetto, Filip ...
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Zhou, Wei
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Abuhakmeh, Youse ...
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Newton, Daniel H ...
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Liu, Christopher ...
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Tinelli, Giovann ...
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Tshomba, Yamume
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Katoh, Airi
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Siada, Sammy S.
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Khashram, Manar
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Gormley, Sinead
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Mullins, John R.
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Schmittling, Zac ...
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Maldonado, Thoma ...
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Politano, Amani ...
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Rynio, Pawel
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Kazimierczak, Ar ...
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Gombert, Alexand ...
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Jalaie, Houman
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Spath, Paolo
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Gallitto, Enrico
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Czerny, Martin
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Berger, Tim
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Davies, Mark G.
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Stilo, Francesco
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Montelione, Nunz ...
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Mezzetto, Luca
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Veraldi, Gian Fr ...
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Lepidi, Sandro
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Lawrence, Peter
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Woo, Karen
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