THE ALGORITHM FOR THE TREATMENT OF OCCLUSIVE LESIONS OF SUBCLAVIAN ARTERIES WITH SPINAL-SUBCLAVIAN STEAL SYNDROME AND CONCOMITANT STENOSIS OF CAROTID ARTERIES

Abstract

Objective. To improve the results of surgical treatment of occlusal lesions of subclavian arteries with spinal-subclavian steal syndrome and combined stenosis of carotid arteries. Methods. 90 patients aged 37-86 years (69 men and 21 women) with a lesion of the first segment of the subclavian arteries were examined in the department of vascular surgery of the Amur Regional Clinical Hospital, from 2010 to 2016. Lesion of the left subclavian artery was detected in 79 (87.8 %), and of the right one - in 11 (12.2 %) patients. Syndrome of vertebral-subclavian stealing was diagnosed in 87 cases (96.6 %), 42 patients (46.6 %) had concomitant stenosis of the internal carotid artery. Results. A total of 72 patients were operated, including 34 patients with concomitant stenosis of the carotid arteries. Depending on the strategy of surgical treatment, all patients are divided into two groups with comparable clinical characteristics. The first included 28 people surgical treatment was performed based on the developed algorithm, the second (control) group included 44 people. In 52 cases stenting of the subclavian artery was performed, in 20 - carotid-subclavian shunting, and in 8 one-stage ipsilateral carotid endarterectomy and carotid-subclavian shunting were performed. Preliminary carotid endarterectomy was performed in 11 patients, carotid endarterectomy was performed in the second stage in 15 patients. The frequency of perfusion complications was lower in the main group. Conclusions. The developed algorithm of revascularization with occlusive lesion of subclavian arteries and combined stenosis of carotid arteries allows to reduce the number of perfusion complications.