Open versus endovascular treatment of subclavian artery atherosclerotic disease.

OBJECTIVE: The aim of this study was to compare open and endovascular treatment of patients with subclavian artery atherosclerotic disease (SAAD) as far as early and late outcomes are concerned.

METHODS: A systematic literature review conforming to established criteria was conducted to identify eligible articles published before January 2018. The following online search engines were used: PubMed, Embase, Scopus, and Cochrane Library (search conducted between December 2017 and January 2018). Eligible studies compared early and late major outcomes between open and endovascular therapy for patients suffering from SAAD.

RESULTS: Overall, seven clinical studies included 731 patients undergoing 760 procedures in total (297 endovascular and 463 open procedures). The majority of procedures (99.7%) referred to symptomatic patients, and more patients undergoing open surgery had an occlusion compared with patients undergoing endovascular repair, the majority of whom had a stenosis. Regarding early outcomes (30-day death, cardiac events, technical success, and central nervous system events), there was no difference between the two methods. Only peripheral nervous system complications were more prevalent in patients undergoing open repair (odds ratio [OR], 7.01; 95% confidence interval [CI], 2.142-22.921; P = .001). Regarding late outcomes, open repair was associated with significantly higher 1-year (OR, 4.33; 95% CI, 1.954-9.619; P = .0003), 3-year (OR, 5.67; 95% CI, 2.881-11.167; P < .0001), and 5-year (OR, 4.27; 95% CI, 1.906-9.567; P = .0004) primary patency rates compared with endovascular therapy. However, 5-year freedom from recurrent symptoms as well as 5-year overall survival showed no difference.

CONCLUSIONS: Open repair and endovascular repair in patients with SAAD do not show any difference concerning the majority of early major outcomes, although more patients undergoing open repair had an occlusion. However, open surgery seems to prevail regarding long-term primary patency, although long-term survival and freedom from recurrent symptoms show no difference.