Ergebnisse nach Supraaortaler Stentangioplastie: Eine retrospektive Analyse

Für die Studienpopulation von 34 Patienten, die von 2002 bis 2012 mittels Stentangioplastie der Arteria subclavia und Truncus brachiocephalicus behandelt wurden, konnten die anfangs gestellten Fragestellungen folgendermaßen beantwortet werden: Von den 34 interventionell behandelten Patienten ware...

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Bibliographic Details
Main Author: Tamburrini, Luca
Contributors: Mahnken, Andreas (Prof. Dr.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2019
Online Access:PDF Full Text
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Table of Contents: For the study population of 34 patients who were treated from 2002 to 2012 with stentangioplasty of the subclavian artery and truncus brachiocephalicus, the initial questions were answered as follows: Of the 34 interventionally treated patients, 55.9% were male and 44.1% female. The average age was 66.4 ± 11.39 years. 61.8% had hypertension, 5.9% had diabetes mellitus type 2 and 38.2% had hyperlipoproteinemia. 41,2% of the patients were smokers. In the study population, oncological pre-existing conditions were above average. represented by 29.4%. An above-average number of closures were recanalized. Patients with coronary heart disease were represented with 23.5%. They were more cancers overall and with 35.3% more closures than in comparable collectives. Technical and post-intervention clinical success was 91.2% on average. The complication rate was 2.9%. There was an ischemia of the hand due to an acute occlusion of the ipsilateral vertebral artery, brachial artery and interosseous artery. There were no transfusion-needy bleedings or direct periprocedural deaths during the observation period. There were no transfusion-needy bleedings or direct periprocedural deaths during the observation period. The primary patency rate was 81.0% after one year, 75.7% after two years, 68.8% after two years. after three years and 64.8% after five and ten years respectively. The secondary openness rate over ten years was 83.3%. Total mortality was 29.4%. Cumulative survival after ten years was 51.9%. For smokers, a cumulative primary patency rate over ten years was 71.4%. compared to 58.2% in the rest of the collective. The cumulative primary openness rate over 10 years for the group of the Hypertensive 63.8% and 67.3% respectively for the non-hypertensive group The cumulative primary patency and for the collective without hyperlipoproteinemia 55.4% over 10 years. The following mortality rates were observed for cardiovascular risk factors: Smoking 14.3%, hypertension 38.1%, hyperlipoproteinemia 15.4%, diabetes mellitus without death. Oncologic patients with pre-existing conditions showed lower primary openness rates of 37.0% after 10 years. Both comorbidities showed an increased mortality after 10 years: 60%. in the group of oncologically pre-existing patients and 50% in the group of those with coronary heart disease. As the only comorbidity, the risk factor "previous oncological disease" showed a significance in the Fischer test with p=0.03 with respect to the Frequency for the event "death". In addition, patients with oncological pre-existing conditions showed significantly the greatest Risk for restenosis with a hazard ratio of 3.8 (1.05 - 13.82 95% KI; p=0.04) in the Comparison with literature. The study collectives showed patient numbers between 14 and 148 patients. In the collectives, patients suffering from diabetes mellitus were much more frequent. than in our collective with only two cases. However, a comparatively low a high incidence of oncologically ill patients in our collective. In the Most studies did not mention the rate of oncological patients. Also more closures were observed than in the reference collectives. The technical and clinical success was comparable to that of the other collectives. In the literature data, the primary openness rate for the one-year period after stent implantation values between 92% and 100% are given, and for the primary Long-term openness rate after 10 years values between 49% and 67.3%. Thus our collective with 81.9%, for the one-year primary openness rate among literature collectives but on average 64.8% for the 10-year data. In summary, the long-term results of up to ten years with the Literature comparable data. Clinically, the vast majority of patients showed a significant Symptom improvement can be achieved at a low complication rate. Thus, our study confirms the conclusion that the interventional therapy of the Arteria subclavia and Truncus brachiocephalicus a safe and promising treatment method, especially in symptomatic patients.