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Objectives: Endovascular treatment of atherosclerotic obstruction of aortic arch branch origins (AABO) has largely replaced open surgery, but long-term outcome data are lacking. This study evaluated mid-term and long-term results of these procedures., Design: Retrospective cohort study., Materials and Methods: Patients underwent endovascular treatment for symptomatic atherosclerotic stenosis of AABO between 1995 and 2012. Technical success was defined as uncomplicated revascularization and residual stenosis ≤30%. The primary end point was freedom from restenosis ≥50% on Duplex ultrasonography or magnetic resonance angiography. Secondary end points were freedom from target lesion revascularization or recurrent symptoms., Results: 144 lesions were treated in 114 patients (75 female; mean age 66.3 years), by percutaneous transluminal angioplasty (PTA) in 20 patients and PTA and stent in 117 patients (brachiocephalic artery [BCA] 9/54; left common carotid artery [LCCA] 0/7; left subclavian artery [LSA] 11/56). The lesion could not be passed in four patients, and in three patients the intervention was terminated before angioplasty. The 30-day technical success was 94.4%, without deaths or strokes. Mean follow-up was 52.0 months (range 2-163 months). Restenosis-free survival was 95.6%, 92.9%, 87.6%, and 83.2% at 12, 24, 48, and 60 months, respectively. Log-rank test showed no significant difference between PTA only and PTA with additional stent placement at any point (p = .375), nor between BCA (n = 51), LCCA (n = 6), or LSA (n = 57). During follow-up, 27 patients (23.7%) became symptomatic (15 BCA, 1 LCCA, and 11 LSA); 19 patients with a restenosis of the target lesion (mean 56.7 months). Symptom-free survival was 94.7%, 92.0%, 82.3%, and 77.9% at 12, 24, 48, and 60 months, respectively., Conclusion: Endovascular treatment of aortic arch branch origin obstruction is safe and efficacious in experienced hands and can be considered as the preferred treatment, with good mid-term durability. Recurrent symptomatic lesions can be treated safely by renewed endovascular means., (Copyright © 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

A systemic review of published reports on the incidence of early (<30 days) adverse events occurring after above- or below-knee femoropopliteal bypass surgery was conducted to provide contemporary outcomes data for comparative reporting. A total of 38 articles were included describing 6,374 femoropopliteal bypasses in 6,007 patients. Fifty-two percent were male and the mean age was 64.6 years (range, 40 to 93 years). The various studied types of complications were reported in 10 to 34 of 38 articles and definitions were often missing. The overall 30-day morbidity rate was 36.8%. The wound infection rate was 7.8% (range, 0.0 to 17.4%) accompanied with dermal necrosis in 0.4%. Graft infection was described in 2.4% (range, 0.0 to 5.3%) of cases. Postoperative bleeding was seen in 7.4% (range, 0.0 to 26%), of which 2.5% required return to surgery. Occlusions were reported in 12.0% (range, 0.0 to 59%). Lymphedema occurred in 2.9% (range, 0.0 to 9.6%) of cases and surgical site seroma formation occurred in 2.0% (range, 1.0% to 3.0%). Overall 30-day mortality rate was 2.3% (range 0.0 to 4.3%). Pooled data comparing vein grafts and prosthetic grafts revealed no significant difference (P = .10; risk ratio = 0.82; 95% confidence interval, 0.66-1.03; I(2) = 0%) in the incidence of complications. This review confirmed the morbidity of femoropopliteal bypass surgery is inconsistently reported and definitions are lacking. Because one-third of patients can be expected to experience an adverse event after femoropopliteal bypass grafting, standards on defining and reporting complications are necessary if comparative outcome standards are developed., (Copyright © 2015 Elsevier Inc. All rights reserved.)