Stenting of Subclavian Artery True and False Aneurysms: A Systematic Review (original) (raw)

Abstract

Background: Aneurysms of the subclavian artery are usually the result of trauma, atherosclerosis or thoracic outlet syndrome. Until the 90's, open surgical repair was considered the only therapeutic choice, exhibiting high complication rates. Since the first report of endovascular repair of subclavian aneurysms in 1991, promising results have been published. Objectives: To summarize all available data on SA true and false aneurysm stenting in order to reach conclusions regarding morbidity, mortality and other procedure-related characteristics Materials & Methods: A Systematic Review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Eligible studies were sought in the Medline (PubMed), ClinicalTrials.gov and Cochrane library-Cochrane Central Register of Controlled Trials (CENTRAL) databases through February, 2017 using the following MeSH terms: ''endovascular'', ''hybrid'', ''aneurysm'', ''pseudoaneurysm'', ''pseudo-aneurysm'', ''false aneurysm'', ''arterial injury'', ''subclavian artery'', ''axillo-subclavian'' and ''axillosubclavian artery". The reference lists of eligible articles and pertinent reviews were screened for potential relevant studies. Results: Seventy-three studies encompassing data on 142 patients who underwent endovascular or hybrid SA aneurysm repair, were deemed eligible. 147 stents and stentgrafts were used. Median age of all patients was 56 years and males comprised 46% of the study sample. Trauma was the most common mechanism of injury. Pulsatile mass or hematoma was the most frequent presenting sign. Pseudoaneurysms were the most frequent type of aneurysms, followed by true aneurysms. Most authors used self-expanding PTFE-covered stents. Access was obtained by either brachial, femoral or both arteries. Through-and-through technique was also used in angulated vessels. All-cause mortality was 10.6%, slightly higher to that already reported in literature, and lower to the respective rate of the open repair. Re-intervention rate was 8.5% despite the high 15.5% complication rate. Conclusions: Endovascular SA aneurysm repair is a technically feasible technique, useful in both elective and emergency cases. Although preliminary results quote its safety and efficacy, larger cohort studies are warranted in order to elucidate its benefit in treating SA aneurysms.

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