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Van Nut L, Vinh PX, Vuong NL. Endovascular Treatment for Subclavian Artery Stenosis and Occlusion: A Single-Center Retrospective Study. Cureus 2023; 15:e44699. [PMID: 37809157 PMCID: PMC10552060 DOI: 10.7759/cureus.44699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Subclavian artery stenosis and occlusion are common arterial diseases in the upper extremities, with atherosclerosis being the main cause. Endovascular treatment has emerged as a promising alternative to open surgical repair, but data are limited. This study aimed to evaluate the safety and effectiveness of endovascular procedures in the treatment of subclavian artery lesions at a tertiary vascular center in Vietnam. METHODS A retrospective analysis was conducted on patients who underwent endovascular treatment for symptomatic subclavian artery stenosis or occlusion between October 2013 and April 2022. Clinical characteristics, procedural details, short- and long-term outcomes, and patency rates were assessed. RESULTS Twenty-five patients were included in the study, with a mean age of 56.8 years. The majority of patients had risk factors for atherosclerosis, and all presented with symptoms related to subclavian artery disease. The endovascular procedures were successful in 96% of cases, with a low complication rate of 8%. During a median follow-up of 43 months, the overall patency rate was 92% at three years. CONCLUSION Endovascular treatment of subclavian artery stenosis and occlusion is a safe and effective option, with excellent long-term patency rates. These findings support the use of percutaneous revascularization as the first-line therapy, particularly in experienced centers. Further studies with larger sample sizes and longer follow-up periods are needed to confirm these results.
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Affiliation(s)
- Lam Van Nut
- Department of Vascular Surgery, Cho Ray Hospital, Ho Chi Minh City, VNM
| | - Pham Xuan Vinh
- Thoracic and Vascular Department, Thu Duc City Hospital, Ho Chi Minh City, VNM
| | - Nguyen Lam Vuong
- Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
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Mendez AA, Mendez-Ruiz A, Fakih R, Farooqui M, Dandapat S, Ortega-Gutierrez S. Combined Transradial and Transfemoral Approach Using a Compliant Balloon for Emboli Protection at the Vertebral Artery During Subclavian Stenosis Stenting: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 20:E376-E377. [PMID: 33484261 DOI: 10.1093/ons/opaa470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/11/2020] [Indexed: 11/14/2022] Open
Abstract
Endovascular intervention has become the mainstay of treatment for subclavian artery stenosis in many centers, with high technical success and low complication rates.1,2 However, potential embolization during proximal subclavian artery intervention can lead to catastrophic posterior circulation ischemic complications.3-5 Although considered a rare complication, the presence of a contralateral hypoplastic vertebral artery with persisting anterograde vertebral blood flow on the affected side is likely to increase the risk of embolization.3 The use of embolic protection devices, such as filters and noncompliant balloons, has been previously described.3,6,7 However, there is still a risk of distal embolization and vessel injury with the use of these devices.7 We present a technical video of a patient in their 80s with left subclavian stenosis who underwent subclavian stent-assisted percutaneous transluminal angioplasty (SAPTA) using an anterograde-retrograde access technique with a dual-lumen compliant balloon catheter (Scepter XC; MicroVention, Aliso Viejo, California) placed at the proximal segment of the left vertebral artery. With this approach, the compliant balloon provides adequate protection while minimizing the risk of endothelial injury and distal embolization. Written informed consent was obtained for the procedure. Patient consent was waived because all health information was deidentified.
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Affiliation(s)
- Aldo A Mendez
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Alan Mendez-Ruiz
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Rami Fakih
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Mudassir Farooqui
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Sudeepta Dandapat
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Santiago Ortega-Gutierrez
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.,Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa.,Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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3
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Patel RAG, White CJ. Brachiocephalic and subclavian stenosis: Current concepts for cardiovascular specialists. Prog Cardiovasc Dis 2021; 65:44-48. [PMID: 33744380 DOI: 10.1016/j.pcad.2021.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 03/13/2021] [Indexed: 01/07/2023]
Abstract
Brachiocephalic and subclavian artery stenoses are less common manifestations of peripheral arterial disease (PAD) compared to lower extremity PAD. However, even among asymptomatic patients, a diagnosis of PAD portends worse long-term mortality. Symptoms may include subclavian steal syndrome and arm claudication. Among patients with internal mammary coronary bypass grafts, symptoms may include those of myocardial ischemia. Symptomatic subclavian stenosis can be readily treated using endovascular techniques with durable outcomes.
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Affiliation(s)
- Rajan A G Patel
- Department of Cardiology, John Ochsner Heart & Vascular Institute, Ochsner Medical Center and Ochsner Clinical School, University of Queensland, Australia.
| | - Christopher J White
- Department of Cardiology, John Ochsner Heart & Vascular Institute, Ochsner Medical Center and Ochsner Clinical School, University of Queensland, Australia
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4
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Saha T, Naqvi SY, Ayah OA, McCormick D, Goldberg S. Subclavian Artery Disease: Diagnosis and Therapy. Am J Med 2017; 130:409-416. [PMID: 28109967 DOI: 10.1016/j.amjmed.2016.12.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 12/07/2016] [Accepted: 12/07/2016] [Indexed: 12/16/2022]
Abstract
The diagnosis of brachiocephalic disease is often overlooked. Symptoms include arm claudication and vertebrobasilar insufficiency. In patients who have had the use of the internal mammary artery for coronary bypass surgery, the development of symptoms of myocardial ischemia should alert the clinician to the possibility of subclavian artery stenosis. Also, in patients who have had axillofemoral bypass, lower-extremity claudication may occur. Recognition involves physical examination and accurate noninvasive testing. Endovascular therapy has proven to be effective in alleviating symptoms in properly selected patients.
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Affiliation(s)
- Tisa Saha
- Department of Internal Medicine, Pennsylvania Hospital of the University of Pennsylvania, Philadelphia.
| | - Syed Yaseen Naqvi
- Department of Internal Medicine, Pennsylvania Hospital of the University of Pennsylvania, Philadelphia
| | - Omar Abine Ayah
- Department of Internal Medicine, Pennsylvania Hospital of the University of Pennsylvania, Philadelphia
| | - Daniel McCormick
- Department of Internal Medicine, Pennsylvania Hospital of the University of Pennsylvania, Philadelphia
| | - Sheldon Goldberg
- Department of Internal Medicine, Pennsylvania Hospital of the University of Pennsylvania, Philadelphia
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5
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Ben Ahmed S, Benezit M, Hazart J, Brouat A, Daniel G, Rosset E. Outcomes of the Endovascular Treatment for the Supra-Aortic Trunks Occlusive Disease: A 14-Year Monocentric Experience. Ann Vasc Surg 2016; 33:55-66. [DOI: 10.1016/j.avsg.2016.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 02/14/2016] [Accepted: 02/27/2016] [Indexed: 11/15/2022]
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Alkhouli M, Porter J, Waits B, Ling FS, Narins CR. Distal Embolization During Percutaneous Subclavian Artery Intervention. Vasc Endovascular Surg 2016; 50:175-9. [DOI: 10.1177/1538574416638758] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Distal embolization due to atherothrombotic debris during subclavian artery interventions is extremely rare and can usually be managed conservatively. Herein, we describe a case of acute hand ischemia due to massive distal embolization during balloon angioplasty and stenting of a left subclavian artery chronic total occlusion. This limb-threatening complication was effectively treated with rescue surgical thrombectomy.
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Affiliation(s)
- Mohamad Alkhouli
- Division of Cardiovascular Diseases, University of Rochester, Rochester, NY, USA
| | - John Porter
- Vascular Surgery Division, University of Rochester, Rochester, NY, USA
| | - Bryan Waits
- Division of Cardiovascular Diseases, University of Rochester, Rochester, NY, USA
| | - Frederick S. Ling
- Division of Cardiovascular Diseases, University of Rochester, Rochester, NY, USA
| | - Craig R. Narins
- Division of Cardiovascular Diseases, University of Rochester, Rochester, NY, USA
- Vascular Surgery Division, University of Rochester, Rochester, NY, USA
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Duran M, Grotemeyer D, Danch MA, Grabitz K, Schelzig H, Sagban TA. Subclavian Carotid Transposition: Immediate and Long-Term Outcomes of 126 Surgical Reconstructions. Ann Vasc Surg 2015; 29:397-403. [DOI: 10.1016/j.avsg.2014.09.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 09/17/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
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Bradaric C, Kuhs K, Groha P, Dommasch M, Langwieser N, Haller B, Ott I, Fusaro M, Theiss W, von Beckerath N, Kastrati A, Laugwitz KL, Ibrahim T. Endovascular Therapy for Steno-Occlusive Subclavian and Innominate Artery Disease. Circ J 2015; 79:537-43. [DOI: 10.1253/circj.cj-14-0855] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Christian Bradaric
- Department of Cardiology, Klinikum Rechts der Isar, Technische Universität München
| | - Kristin Kuhs
- Department of Cardiology, Klinikum Rechts der Isar, Technische Universität München
| | - Philip Groha
- Department of Cardiology, Klinikum Rechts der Isar, Technische Universität München
| | - Michael Dommasch
- Department of Cardiology, Klinikum Rechts der Isar, Technische Universität München
| | - Nicolas Langwieser
- Department of Cardiology, Klinikum Rechts der Isar, Technische Universität München
| | - Bernhard Haller
- Department of Medical Statistics and Epidemiology, Klinikum Rechts der Isar, Technische Universität München
| | - Ilka Ott
- German Heart Centre Munich, Technische Universität München
| | | | - Wolfram Theiss
- Department of Cardiology, Klinikum Rechts der Isar, Technische Universität München
| | | | - Adnan Kastrati
- DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance
- German Heart Centre Munich, Technische Universität München
| | - Karl-Ludwig Laugwitz
- DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance
- Department of Cardiology, Klinikum Rechts der Isar, Technische Universität München
| | - Tareq Ibrahim
- Department of Cardiology, Klinikum Rechts der Isar, Technische Universität München
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Bényi Z, Nagy G, Nyirati G, Szentpétery L, Vallus G. A diabetic patient with asymptomatic multiple arterial disease. Orv Hetil 2012; 153:1475-9. [DOI: 10.1556/oh.2012.29460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The authors present the case of a 73-year-old diabetic woman who was referred to hospital because of the suspicion of lower limb peripheral arterial stenosis. During evaluations signs of the subclavian artery occlusion were found. In addition to diabetes, the patient had several risk factors revealed by medical history. Subclavian artery occlusion was solved by angiography guided stenting, and angiography also showed the presence of abnormalities in renal arteries. This case draws the attention to the importance of screening old diabetic patients for arterial stenosis and the importance of accurate risk factor assessment. Orv. Hetil., 2012, 153, 1475–1479.
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Affiliation(s)
- Zoltán Bényi
- Bajai Szent Rókus Kórház II. Belgyógyászat Baja Rókus u. 10. 6500
| | - György Nagy
- Bajai Szent Rókus Kórház II. Belgyógyászat Baja Rókus u. 10. 6500
| | - Gábor Nyirati
- Bajai Szent Rókus Kórház II. Belgyógyászat Baja Rókus u. 10. 6500
| | | | - Gábor Vallus
- MH Honvédkórház Általános és Érsebészeti Osztály Budapest
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10
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Endovascular stenting for atherosclerotic subclavian artery stenosis in patients with other craniocervical artery stenosis. J Thromb Thrombolysis 2012; 35:107-14. [PMID: 22872507 DOI: 10.1007/s11239-012-0789-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Atherosclerotic subclavian artery stenosis (SAS) accompanied with other craniocervical artery stenosis (OCAS) is not uncommon in practice. We sought to investigate the safety and efficacy of endovascular stenting for SAS in patients with OCAS. Between January 2004 and February 2012, 71 consecutive atherosclerotic SAS patients who underwent primary stenting in our medical center were included. The enrolled patients were divided into combined-SAS group (n = 51) and solitary-SAS group (n = 20) depending on the presence or absence of OCAS. Data of demographics, procedure, and the followed-up were retrieved and analyzed. The technical success rate was 95.8%; the clinical success rate was 90.1%. There was no catheter-related major stroke or death. The immediate outcomes had no statistical difference between groups. During a mean of 27 ± 20 months (range 2-88 months) followed-up, 7 (10.3%) restenosis and 12 (17.6%) clinical events were identified. The primary patency rate was 95.3, 84.9 and 84.9% at 12, 24 months, and final followed-up respectively, which had no statistical difference between groups (odds ratio (OR), 2.60; 95% confidence interval (CI), 0.54-12.53; P = 0.232). The overall clinical event-free survival rate was 93.5, 86.2 and 54.6%, respectively, where the result of combined-SAS group was inferior to that of the solitary-SAS group (OR, 3.34; 95% CI, 1.02-11.00; P = 0.047). Endovascular stenting was safe and feasible for atherosclerotic SAS in patients with OCAS, although the combined OCAS may have a significant influence on the long-term outcome. Further studies are warrant to investigate the effects of revascularization for multiple craniocervical artery stenoses on the cerebral hemodynamics and long-term outcomes.
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