Skip to main content
Erschienen in: CardioVascular and Interventional Radiology 2/2012

01.04.2012 | Clinical Investigation

Initial and Long-Term Results of Endovascular Therapy for Chronic Total Occlusion of the Subclavian Artery

verfasst von: Srdjan Babic, Dragan Sagic, Djordje Radak, Zelimir Antonic, Petar Otasevic, Vladimir Kovacevic, Slobodan Tanaskovic, Dusan Ruzicic, Nikola Aleksic, Goran Vucurevic

Erschienen in: CardioVascular and Interventional Radiology | Ausgabe 2/2012

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To study the initial and long-term results of angioplasty and primary stenting for the treatment of chronic total occlusion (CTO) of the subclavian artery (SA).

Materials and Methods

From January 1999 to February 2010, 56 patients (25 men with a mean age of 58 ± 8 years) underwent endovascular treatment for CTO of the SA. Duplex scans and arteriograms confirmed occlusion in all cases. Indications for recanalization were subclavian steal syndrome in 33 patients (58.1%), arm claudication in 13 patients (23.2%), and coronary ischemia in 7 patients (12.5%) who had a history of previous coronary artery bypass grafting that included left internal thoracic artery graft. Three patients (5.4%) were treated before the scheduled coronary artery bypass surgery, which included left internal thoracic artery graft. After successful recanalization, all arteries were stented, and all of the patients were followed-up at 1, 3, 6, and 12 months after surgery and annually thereafter.

Results

Successful recanalization of the SA was achieved in 46 patients (82.1%), and the complication rate was 7.1%. During follow-up (mean 40 ± 26 months; range 2 to 125), the primary patency rates after 1 and 3 years were 97.9% and 82.7%, respectively. At the end of follow-up, 76% of the arteries showed no evidence of restenosis. Univariate analysis failed to identify any variable predictive of long-term patency of successfully recanalized SA.

Conclusion

Percutaneous transluminal angioplasty with stenting of the complete total occlusion of the SA is a safe and effective procedure associated with low risks and good long-term results.
Literatur
1.
Zurück zum Zitat Fields WS, Lemak NA (1972) Joint study of extracranial arterial occlusion. Subclavian steal: a review of 168 cases. JAMA 222:1139–1143PubMedCrossRef Fields WS, Lemak NA (1972) Joint study of extracranial arterial occlusion. Subclavian steal: a review of 168 cases. JAMA 222:1139–1143PubMedCrossRef
2.
Zurück zum Zitat Bates MC, Broce M, Lavigne PS, Stone P (2004) Subclavian artery stenting: factors influencing long-term outcome. Catheter Cardiovasc Interv 61:5–11PubMedCrossRef Bates MC, Broce M, Lavigne PS, Stone P (2004) Subclavian artery stenting: factors influencing long-term outcome. Catheter Cardiovasc Interv 61:5–11PubMedCrossRef
3.
Zurück zum Zitat Motarjeme A, Keifer JW, Zuska AJ, Nabawi P (1985) Percutaneous transluminal angioplasty for treatment for subclavian steal. Radiology 155:611–613PubMed Motarjeme A, Keifer JW, Zuska AJ, Nabawi P (1985) Percutaneous transluminal angioplasty for treatment for subclavian steal. Radiology 155:611–613PubMed
4.
Zurück zum Zitat Sullivan TM, Gray BH, Bacharach JM, Perl J 2nd, Childs MB, Modzelewski L et al (1998) Angioplasty and primary stenting of the subclavian, innominate, and common carotid arteries in 83 patients. J Vasc Surg 28:1059–1065PubMedCrossRef Sullivan TM, Gray BH, Bacharach JM, Perl J 2nd, Childs MB, Modzelewski L et al (1998) Angioplasty and primary stenting of the subclavian, innominate, and common carotid arteries in 83 patients. J Vasc Surg 28:1059–1065PubMedCrossRef
5.
Zurück zum Zitat Henry M, Amor M, Henry I, Ethevenot G, Tzvetanov K, Chati Z (1999) Percutaneous transluminal angioplasty of the subclavian arteries. J Endovasc Surg 6:33–41PubMedCrossRef Henry M, Amor M, Henry I, Ethevenot G, Tzvetanov K, Chati Z (1999) Percutaneous transluminal angioplasty of the subclavian arteries. J Endovasc Surg 6:33–41PubMedCrossRef
6.
Zurück zum Zitat Westerband A, Rodriguez JA, Ramaiah VG, Diethrich EB (2003) Endovascular therapy in prevention and management of coronary-subclavian steal. J Vasc Surg 38:699–703PubMedCrossRef Westerband A, Rodriguez JA, Ramaiah VG, Diethrich EB (2003) Endovascular therapy in prevention and management of coronary-subclavian steal. J Vasc Surg 38:699–703PubMedCrossRef
7.
Zurück zum Zitat Martinez R, Rodriguez-Lopez J, Torruella L, Ray L, Lopez-Galarza L, Diethrich EB (1997) Stenting for occlusion of the subclavian arteries. Tex Heart Inst J 24:23–27PubMed Martinez R, Rodriguez-Lopez J, Torruella L, Ray L, Lopez-Galarza L, Diethrich EB (1997) Stenting for occlusion of the subclavian arteries. Tex Heart Inst J 24:23–27PubMed
8.
Zurück zum Zitat Al-Mubarak N, Liu MW, Dean LS, Al-Shaibi K, Chastain HD 2nd, Lyer SS et al (1999) Immediate and late outcomes of subclavian artery stenting. Catheter Cardiovasc Interv 46:169–172PubMedCrossRef Al-Mubarak N, Liu MW, Dean LS, Al-Shaibi K, Chastain HD 2nd, Lyer SS et al (1999) Immediate and late outcomes of subclavian artery stenting. Catheter Cardiovasc Interv 46:169–172PubMedCrossRef
9.
Zurück zum Zitat Rodriguez-Lopez JA, Werner A, Martinez R, Torruella LJ, Ray LI, Diethrich EB (1999) Stenting for atherosclerotic occlusive disease of the subclavian artery. Ann Vasc Surg 13:254–260PubMedCrossRef Rodriguez-Lopez JA, Werner A, Martinez R, Torruella LJ, Ray LI, Diethrich EB (1999) Stenting for atherosclerotic occlusive disease of the subclavian artery. Ann Vasc Surg 13:254–260PubMedCrossRef
10.
Zurück zum Zitat Pollard H, Rigby S, Moritz G, Lau C (1998) Subclavian steal syndrome. A review. Australas Chiropr Osteopathy 7:20–28PubMed Pollard H, Rigby S, Moritz G, Lau C (1998) Subclavian steal syndrome. A review. Australas Chiropr Osteopathy 7:20–28PubMed
11.
Zurück zum Zitat Hadjipetrou P, Cox S, Piemonte T, Eisenhauer A (1999) Percutaneous revascularization of atherosclerotic obstruction of aortic arch vessels. J Am Coll Cardiol 33:1238–1245PubMedCrossRef Hadjipetrou P, Cox S, Piemonte T, Eisenhauer A (1999) Percutaneous revascularization of atherosclerotic obstruction of aortic arch vessels. J Am Coll Cardiol 33:1238–1245PubMedCrossRef
12.
Zurück zum Zitat Mathias K, Jaeger H (1999) Proximal subclavian artery obstruction. In: Henry M, Amor M (eds) Tenth international course book of peripheral vascular intervention (ETC). Europa Organisation, Toulouse, France, pp 607–616 Mathias K, Jaeger H (1999) Proximal subclavian artery obstruction. In: Henry M, Amor M (eds) Tenth international course book of peripheral vascular intervention (ETC). Europa Organisation, Toulouse, France, pp 607–616
13.
Zurück zum Zitat Eisenhauer AC, Shaw JA (2004) Atherosclerotic subclavian artery disease and revascularization. In: Abele GS (ed) Peripheral vascular disease, diagnostic and therapeutic approach. Lippioncott Williams & Wilkins, Philadelphia, pp 283–294 Eisenhauer AC, Shaw JA (2004) Atherosclerotic subclavian artery disease and revascularization. In: Abele GS (ed) Peripheral vascular disease, diagnostic and therapeutic approach. Lippioncott Williams & Wilkins, Philadelphia, pp 283–294
14.
Zurück zum Zitat Mathias K, Schlosser V, Reinke M (1980) Katheterrekanalisation eines Subklaviaverschlusses. Roentgen Foretrific 132:346–347CrossRef Mathias K, Schlosser V, Reinke M (1980) Katheterrekanalisation eines Subklaviaverschlusses. Roentgen Foretrific 132:346–347CrossRef
15.
Zurück zum Zitat Bachman DM, Kim RM (1980) Transluminal dilatation for subclavian steal syndrome. Am J Roentgenol 135:995–996 Bachman DM, Kim RM (1980) Transluminal dilatation for subclavian steal syndrome. Am J Roentgenol 135:995–996
16.
Zurück zum Zitat Huttl K, Nemes B, Simonffy A, Entz L, Berczi V (2002) Angioplasty of the innominate artery in 89 patients: experience over 19 years. Cardiovasc Intervent Radiol 25:109–114PubMedCrossRef Huttl K, Nemes B, Simonffy A, Entz L, Berczi V (2002) Angioplasty of the innominate artery in 89 patients: experience over 19 years. Cardiovasc Intervent Radiol 25:109–114PubMedCrossRef
17.
Zurück zum Zitat Smith JM, Koury HI, Hafner CD, Welling RE (1994) Subclavian steal syndrome. A review of 59 consecutive cases. J Cardiovasc Surg (Torino) 35:11–14 Smith JM, Koury HI, Hafner CD, Welling RE (1994) Subclavian steal syndrome. A review of 59 consecutive cases. J Cardiovasc Surg (Torino) 35:11–14
18.
Zurück zum Zitat De Vries JP, Jager LC, Van den Berg JC, Overtoom TT, Ackerstaff RG, Van de Pavoordt ED et al (2005) Durability of percutaneous transluminal angioplasty for obstructive lesions of proximal subclavian artery: long term results. J Vasc Surg 41(1):19–23PubMedCrossRef De Vries JP, Jager LC, Van den Berg JC, Overtoom TT, Ackerstaff RG, Van de Pavoordt ED et al (2005) Durability of percutaneous transluminal angioplasty for obstructive lesions of proximal subclavian artery: long term results. J Vasc Surg 41(1):19–23PubMedCrossRef
19.
Zurück zum Zitat Mathias KD, Luth I, Haarmann P (1993) Percutaneous transluminal angioplasty of proximal subclavian artery occlusions. Cardiovasc Intervent Radiol 16:214–218PubMedCrossRef Mathias KD, Luth I, Haarmann P (1993) Percutaneous transluminal angioplasty of proximal subclavian artery occlusions. Cardiovasc Intervent Radiol 16:214–218PubMedCrossRef
20.
Zurück zum Zitat Edwards WH, Mulherin JL Jr (1985) The surgical reconstruction of the proximal subclavian and vertebral artery. J Vasc Surg 2:634–642PubMed Edwards WH, Mulherin JL Jr (1985) The surgical reconstruction of the proximal subclavian and vertebral artery. J Vasc Surg 2:634–642PubMed
21.
Zurück zum Zitat Wylie EJ, Effeney DJ (1979) Surgery of the aortic arch branches and vertebral arteries. Surg Clin North Am 59:669–680PubMed Wylie EJ, Effeney DJ (1979) Surgery of the aortic arch branches and vertebral arteries. Surg Clin North Am 59:669–680PubMed
22.
Zurück zum Zitat Motarjeme A (1996) Percutaneous transluminal angioplasty of supraaortic vessels. J Endovasc Surg 3:171–181PubMedCrossRef Motarjeme A (1996) Percutaneous transluminal angioplasty of supraaortic vessels. J Endovasc Surg 3:171–181PubMedCrossRef
23.
Zurück zum Zitat Motarjeme A, Gordon GI (1993) Percutaneous transluminal angioplasty of the brachiocephalic vessels: guidelines for therapy. Int Angiol 12:260–269PubMed Motarjeme A, Gordon GI (1993) Percutaneous transluminal angioplasty of the brachiocephalic vessels: guidelines for therapy. Int Angiol 12:260–269PubMed
24.
Zurück zum Zitat Düber C, Klose KJ, Kopp H, Schmiedt W (1992) Percutaneous transluminal angioplasty for occlusion of the subclavian artery: short and long term results. Cardiovasc Intervent Radiol 15:205–210PubMedCrossRef Düber C, Klose KJ, Kopp H, Schmiedt W (1992) Percutaneous transluminal angioplasty for occlusion of the subclavian artery: short and long term results. Cardiovasc Intervent Radiol 15:205–210PubMedCrossRef
25.
Zurück zum Zitat Patel SN, White CJ, Collins TJ, Daniel GA, Jenkins JS, Reilly JP et al (2008) Catheter-based treatment of the subclavian and innominate arteries. Catheter Cardiovasc Interv 71(7):963–968PubMedCrossRef Patel SN, White CJ, Collins TJ, Daniel GA, Jenkins JS, Reilly JP et al (2008) Catheter-based treatment of the subclavian and innominate arteries. Catheter Cardiovasc Interv 71(7):963–968PubMedCrossRef
26.
Zurück zum Zitat Przewlocki T, Kablak-Ziembicka A, Pieniazek P, Musialek P, Kadzielski A, Zalewski J et al (2006) Determinants of immediate and long-term results of subclavian and innominate artery angioplasty. Cathet Cardiovasc Interv 67:519–526CrossRef Przewlocki T, Kablak-Ziembicka A, Pieniazek P, Musialek P, Kadzielski A, Zalewski J et al (2006) Determinants of immediate and long-term results of subclavian and innominate artery angioplasty. Cathet Cardiovasc Interv 67:519–526CrossRef
27.
Zurück zum Zitat Wang KQ, Wang ZG, Yang BZ, Yuan C, Zhang WD, Yuan B et al (2010) Long-term results of endovascular therapy for proximal subclavian arterial obstructive lesions. Chin Med J (Engl) 123(1):45–50 Wang KQ, Wang ZG, Yang BZ, Yuan C, Zhang WD, Yuan B et al (2010) Long-term results of endovascular therapy for proximal subclavian arterial obstructive lesions. Chin Med J (Engl) 123(1):45–50
28.
Zurück zum Zitat Hebrang A, Maskovic J, Tomac B (1991) Percutaneous transluminal angioplasty of the subclavian arteries: long term results in 52 patients. AJR Am J Roentgenol 156:1091–1094PubMed Hebrang A, Maskovic J, Tomac B (1991) Percutaneous transluminal angioplasty of the subclavian arteries: long term results in 52 patients. AJR Am J Roentgenol 156:1091–1094PubMed
29.
Zurück zum Zitat Kumar K, Dorros G, Bates MC, Palmer L, Mathiak L, Dufek C (1995) Primary stent deployment in occlusive subclavian artery disease. Cathet Cardiovasc Diagn 34:281–285PubMedCrossRef Kumar K, Dorros G, Bates MC, Palmer L, Mathiak L, Dufek C (1995) Primary stent deployment in occlusive subclavian artery disease. Cathet Cardiovasc Diagn 34:281–285PubMedCrossRef
30.
Zurück zum Zitat Sixt S, Rastan A, Schwarzwälder U, Bürgelin K, Noory E, Schwarz T et al (2009) Results after balloon angioplasty or stenting of atherosclerotic subclavian artery obstruction. Catheter Cardiovasc Interv 73(3):395–403PubMedCrossRef Sixt S, Rastan A, Schwarzwälder U, Bürgelin K, Noory E, Schwarz T et al (2009) Results after balloon angioplasty or stenting of atherosclerotic subclavian artery obstruction. Catheter Cardiovasc Interv 73(3):395–403PubMedCrossRef
31.
Zurück zum Zitat Qi L, Gu Y, Zhang J, Yu H, Li X, Guo L et al (2010) Surgical treatment of subclavian artery occlusion. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 24(9):1030–1032PubMed Qi L, Gu Y, Zhang J, Yu H, Li X, Guo L et al (2010) Surgical treatment of subclavian artery occlusion. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 24(9):1030–1032PubMed
32.
Zurück zum Zitat AbuRahma AF, Robinson PA, Tucker G (2000) Jennings carotid-subclavian bypass grafting with polytetrafluoroethylene grafts for symptomatic subclavian artery stenosis or occlusion: a 20-year experience. J Vasc Surg 32(3):411–419PubMedCrossRef AbuRahma AF, Robinson PA, Tucker G (2000) Jennings carotid-subclavian bypass grafting with polytetrafluoroethylene grafts for symptomatic subclavian artery stenosis or occlusion: a 20-year experience. J Vasc Surg 32(3):411–419PubMedCrossRef
33.
Zurück zum Zitat Schardey HM, Meyer G, Rau HG, Gradl G, Jauch KW, Lauterjung L (1996) Subclavian carotid transposition: an analysis of a clinical series and a review of the literature. Eur J Vasc Endovasc Surg 12:431–436PubMedCrossRef Schardey HM, Meyer G, Rau HG, Gradl G, Jauch KW, Lauterjung L (1996) Subclavian carotid transposition: an analysis of a clinical series and a review of the literature. Eur J Vasc Endovasc Surg 12:431–436PubMedCrossRef
34.
Zurück zum Zitat Schillinger M, Haumer M, Schillinger S, Ahmadi R, Minar E (2001) Risk stratification for subclavian artery angioplasty: is there an increased rate of restenosis after stent implantation? J Endovasc Ther 8:550–557PubMedCrossRef Schillinger M, Haumer M, Schillinger S, Ahmadi R, Minar E (2001) Risk stratification for subclavian artery angioplasty: is there an increased rate of restenosis after stent implantation? J Endovasc Ther 8:550–557PubMedCrossRef
Metadaten
Titel
Initial and Long-Term Results of Endovascular Therapy for Chronic Total Occlusion of the Subclavian Artery
verfasst von
Srdjan Babic
Dragan Sagic
Djordje Radak
Zelimir Antonic
Petar Otasevic
Vladimir Kovacevic
Slobodan Tanaskovic
Dusan Ruzicic
Nikola Aleksic
Goran Vucurevic
Publikationsdatum
01.04.2012
Verlag
Springer-Verlag
Erschienen in
CardioVascular and Interventional Radiology / Ausgabe 2/2012
Print ISSN: 0174-1551
Elektronische ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-011-0144-8

Weitere Artikel der Ausgabe 2/2012

CardioVascular and Interventional Radiology 2/2012 Zur Ausgabe

Darf man die Behandlung eines Neonazis ablehnen?

08.05.2024 Gesellschaft Nachrichten

In einer Leseranfrage in der Zeitschrift Journal of the American Academy of Dermatology möchte ein anonymer Dermatologe bzw. eine anonyme Dermatologin wissen, ob er oder sie einen Patienten behandeln muss, der eine rassistische Tätowierung trägt.

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

07.05.2024 Klinik aktuell Nachrichten

Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.

Endlich: Zi zeigt, mit welchen PVS Praxen zufrieden sind

IT für Ärzte Nachrichten

Darauf haben viele Praxen gewartet: Das Zi hat eine Liste von Praxisverwaltungssystemen veröffentlicht, die von Nutzern positiv bewertet werden. Eine gute Grundlage für wechselwillige Ärztinnen und Psychotherapeuten.

Akuter Schwindel: Wann lohnt sich eine MRT?

28.04.2024 Schwindel Nachrichten

Akuter Schwindel stellt oft eine diagnostische Herausforderung dar. Wie nützlich dabei eine MRT ist, hat eine Studie aus Finnland untersucht. Immerhin einer von sechs Patienten wurde mit akutem ischämischem Schlaganfall diagnostiziert.

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.