XXXX : evolution of management over two decades.

@entity1 @entity64 @entity16 @entity128 @entity439 @entity4435 @entity432 @entity731 @entity2849 @entity438
INTRODUCTION: @entity438 ( @entity4435 ), although uncommon, represents a challenge to treatment strategy. The purpose of this study was to analyze the treatment evolution and clinical outcome of all @entity1 with @entity4435 over a two decade period. METHODS: Clinical data of all @entity1 diagnosed with @entity4435 who underwent interventions from 1984 to 2004 were reviewed. @entity1 were divided into two groups. Group I (1985-1994) and group II (1995-2004) were compared with regards to clinical presentation, treatment modality, and clinical outcome. RESULTS: A total of 42 cases of @entity4435 were found during the study period (group I, n=22; group II, n=20). Pulsatile neck mass was the most common presenting symptom (n=39, 93%), followed by @entity16 (n=6, 14%). Twenty two (52%) were @entity731 , fifteen (36%) @entity2849 , and five (12%) posttraumatic @entity439 . Both groups shared similar comorbidities and demographic profiles. All @entity1 in group I underwent operative interventions, which included 12 resection with interposition bypass grafting (55%), six resection with patch angioplasty (27%), and four carotid ligation (18%). In group II, five @entity1 underwent resection with interposition placement (25%) and one carotid ligation (5%). The remaining 14 @entity1 underwent endovascular interventions (70%) which included seven stent-graft exclusions, six carotid stenting with coil exclusions, and one @entity432 . Hospital length of stay was significantly shorter in group II than group I (3.5 vs. 9.4 days, p<0.01). The incidence of @entity128 in group I and II were 14% vs. 5% (p<0.04), respectively. The 30-day mortality/major @entity64 rates in group I and II were 14% vs. 5% (p< 0.04), respectively. During the follow-up period (0.8 months-20 years; mean, 4.6 years), 16 @entity1 died, largely due to cardiac etiologies (n=11, 69%). CONCLUSIONS: Treatment modality of @entity4435 has largely evolved from operative to endovascular intervention at our institution. Treatment benefits of endovascular modality include shorter convalescent and less procedural-related complications. This evolution reflects the improvement of endovascular devices and increased utility of endovascular applications.
