Short- and Long-Term Outcomes of Endovascular Treatment for Stenoocclusive Lesions of Subclavian Artery

Background: This study aimed to evaluate the results of endovascular therapy for stenoocclusive lesions of subclavian artery (SA) over the medium and long term, through our experience and the ones reported in current literature.

Materials and Methods: Data about consecutive patients treated for subclavian artery stenoocclusive disease between 2013 and 2018 by endovascular repair (ER) were retrospectively collected and analyzed. Primary outcomes included 30- day death, as well as cardiac and neurologic events, were analyzed. Secondary outcomes included primary patency in the long term.

Results: Forty patients were included. The mean age was 61 years (range: 37–89 years), and 57.5% were males. Procedures were performed via radial (6–7 Fr) access in 28 cases (82%) and surgical brachial access in six cases (18%). Percutaneous transangioplasty (PTA) with stent implantation was performed in 31 cases (77.5%), using balloon expandable stents. Three cases (7.5%) was treated with simple balloon angioplasty. Technical success rate was 85% (34 patients); 90% in case of stenosis and 73% in case of occlusions. Symptoms resolution and upper limb salvage were 100%. Periprocedural complication rate was relatively low (4.4%), limited to two cases of hematoma at the access site recovered spontaneously and one case of stent thrombosis occurred at 1 month. The median follow-up was 23 months (range: 12–48 months). Two in-stent restenoses were reported through the follow-up (at 13 and 16 months) in two patients with the Takayasu disease and were treated with drug-eluting balloon angioplasty with favorable outcomes. A case of late stent thrombosis occurred on the 12th month in a patient who had initially been treated for SA occlusion and needed a surgical revascularization by carotid-axillary bypass. Late mortality rate was 0%.Primary patency was 97, 83, 83, and 83% at the 1st, 2nd, 3rd, and 4th years, respectively.

Conclusion: The present study shows that endovascular therapy of stenoocclusive SA was associated with high technical and clinical success rates, low complication rates, and good long-term patency rate.

Publication History

Article published online:
14 December 2021