Stent graft repair of subclavian and axillary XXXX : The Groote Schuur experience.

@entity1 @entity1070 @entity645 @entity2982 @entity1317 @entity2548 @entity204 @entity130
BACKGROUND: @entity130 -related subclavian and axillary @entity1317 (SAVIs) are generally associated with high morbidity and mortality rates in the surgical literature. There is an emerging trend towards increasing use of stent grafts (covered stents) for repair, with evidence limited to small case series and case reports. OBJECTIVES: To report on the clinical and device-related outcomes of stent graft repair of @entity130 -related SAVIs at a single institution. METHODS: A retrospective chart review of all @entity1 with @entity130 -related SAVIs requiring stent graft repair was performed. Outcome measures included technical success, mortality, amputation rate, device-related complications (early and late), and reintervention rates (early and late). RESULTS: A total of 31 @entity1 was identified between June 2008 and October 2013 (30 males, 1 female). Mean age was 27.9 years (range 19 - 51). All 31 @entity1 sustained a @entity2982 (93.5% stab, 6.5% gunshot injuries). There were 21 subclavian and 10 axillary @entity1317 . Five @entity1 (16%) were @entity645 -positive. Nine @entity1 (29%) were shocked on presentation. Early results (30 days): There were no periprocedural @entity204 . Primary technical success was 83.9% (26/31). Five @entity1 required adjunctive interventional or operative procedures. There were no early procedure-related complications, reinterventions or open conversions in this study. Overall, suboptimal results were seen in five @entity1 (one type I endoleak and four @entity1070 ). Follow-up results (>30 days): Nineteen @entity1 (61.3%) were available for follow-up. Mean duration of follow-up was 55.7 weeks (range 4 - 240). Overall stent graft patency was 89.5% (17/19). Four @entity1 (21.1%) had an occluded stent graft. Stent graft salvage was possible in two @entity1 . Three @entity1070 were seen on follow-up. Late reinterventions were performed in five @entity1 (26.3%). Conversion to an open procedure was not required in any @entity1 . There was one late death and one major amputation of a stented limb in a @entity1 who had sustained severe soft-tissue injuries during the follow-up period. CONCLUSION: Perioperative, early and intermediate results suggest that stent graft repair of select @entity130 -related SAVIs is relatively safe and effective. Axillary @entity2548 remain a particular challenge using this treatment modality. Larger prospective studies are required to define the utility of stent grafts for select @entity130 -related SAVIs better.
