Endovascular Treatment of the Occlusive Disease of the Great Vessels of the Aortic Arch

Objective: Endovascular interventions have revolutionized the contemporary treatment of peripheral vascular occlusive disease. Traditional management of Supra-Aortic TrunkS (SATs) occlusive disease has employed surgical bypass via median sternotomy or thoracotomy or extra-anatomic bypass via a cervical approach endoluminal therapy may be a less morbid alternative. Methods: From March 2011 and February 2013, six consecutive patients with great vessel occlusive disease were treated endoluminally with primary stenting. Treated vessels were subclavian (n=4), common carotid (n=1), and axillary (n=1) and). The target lesion was accessed antegrade via the femoral artery (n=4), combined antegrade and retrograde through femoral and brachial artery (n=1) and triple access via both femoral and brachial access (n=1) using flossing technique and contralateral femoral access for angiography. Results: Mean age was 51 years with 5 male and 1 female and all patient were symptomatic with exercise pain (n. 3), rest pain (n.1), color changes (n.1) or Transient Ischemic Attack (TIA) (n.1). Technical success was achieved in 6/6 cases 100%. At 30-day follow-up, there were no deaths, myocardial infarctions, or strokes. TIA occurred in 1 patent with carotid intervention in the 1s t 24 hours after intervention. Follow-up was up to 1 year in all patients with lry patency rate was 91.6% and 2ry patency was 100%. Conclusion: It was found that endo-luminal stenting of the aortic arch vessels is a viable alternative for open surgical bypass and should be the first line of treatment; it has an excellent functional outcome, safety, and midterm results. It has excellent results in cases of focal stenotic and good results in cases of total occlusion and long segment stenosis. Primary stenting may be considered as method for decreasing post-operative angioplasty complications.