Optimal revascularization procedure for steel syndrome

Kazantsev AN, Chernykh KP, Zarkua NE, et al. . Optimal revascularization procedure for steel syndrome. Russian Journal of Cardiology and Cardiovascular Surgery. 2021;14(2):195‑201. (In Russ.)
https://doi.org/10.17116/kardio202114021195

Подписка 2026 Кардиология и сердечно-сосудистая хирургия (Russian Journal of Cardiology and Cardiovascular Surgery)

Использование инфографики авторами научных работ

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Abstract:

OBJECTIVE

To compare in-hospital and long-term results of carotid-subclavian bypass grafting and subclavian-carotid transposition in patients with subclavian artery occlusion and steel syndrome.

MATERIAL AND METHODS

Cohort comparative retrospective open study included 182 patients with subclavian artery for the period from January 2010 and March 2020. Depending on surgical correction, all patients were divided into 2 groups: group 1 (n=95) — carotid-subclavian bypass grafting; group 2 (n=87) — subclavian-carotid transposition. Vascutek prosthesis was used in the first group. In this group, mean follow-up period was 79.8±34.5 months; in group 2 — 83.0±25.1 months. The endpoints of the study were adverse cardiovascular events such as death, myocardial infarction (MI), stroke/transient ischemic attack, thrombosis/restenosis of anastomosis/prosthesis, combined endpoint (death from stroke/transient ischemic attack + MI + stroke/transient ischemic attack).

RESULTS

No in-hospital cardiovascular complications were obtained. In few cases, paresis of the larynx with clinical regression at discharge and chylothorax were observed in both groups. Lymphorrhea was more common after carotid-subclavian bypass grafting (9 (9.5%) vs. 1 (1.1%); p=0.03; OR 9.0; 95% CI 1.11—72.62). Long-term outcomes were comparable in both groups. Carotid-subclavian bypass grafting was followed by higher number of thrombosis of prosthesis/reconstruction zone (5 (5.5%) vs. 0; p=0.08; OR 10.64; 95% CI 0.57—195.4), restenosis (8 (8.4%) vs. 3 (3.4%); p=0.27; OR 2.57; 95% CI 1.11—72.62 ). There was 1 case of prosthetic infection in the same group (p=0.96; OR 2.77; 95% CI 0.11—69.15).

CONCLUSION

Both revascularization techniques are characterized by similar in-hospital efficacy and safety. However, carotid-subclavian bypass grafting was followed by higher incidence of early postoperative lymphorrhea, graft dysfunction with associated ischemic complications in long-term follow-up period and higher risk of infectious complications with sepsis and bleeding. Considering these data, carotid-subclavian bypass grafting is less preferable for subclavian artery occlusion and steel syndrome.

Keywords:

carotid-subclavian bypass grafting

subclavian-carotid transposition

steel syndrome

suppuration of prosthesis

SYNTAX

EuroSCORE II

Vascutek

in-hospital results

long-term results

subclavian artery occlusion

Authors:

Kazantsev A.N.

St. Petersburg City Alexandrovskaya Hospital

SPIN RSCI: 8396-1845
Scopus AuthorID: 57196122083
ORCID: 0000-0002-1115-609X

Chernykh K.P.

St. Petersburg City Alexandrovskaya Hospital

ORCID: 0000-0002-5089-5549

Zarkua N.E.

Alexandrovskaya Hospital

ORCID: 0000-0002-7457-3149

Lider R.Yu.

Kemerovo State Medical University

Bagdavadze G.Sh.

Alexandrovskaya Hospital

ORCID: 0000-0001-5970-6209

Kalinin E.Yu.

Alexandrovskaya Hospital

ORCID: 0000-0003-3258-4365

Chikin A.E.

Alexandrovskaya Hospital

ORCID: 0000-0001-6539-0386

Linets Yu.P.

Alexandrovskaya Hospital

ORCID: 0000-0002-2279-3887

Received:

20.04.2020

Accepted:

03.08.2020

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