Saadat Shariff1, Isabella Alviz2, Cornelia Rivera3, Michelle Cortorreal3, and Tyrone J. Collins4 1 Department of Cardiothoracic & Vascular Surgery (Vascular Surgery), Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, NY, USA 2 Department of Medicine, Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, NY, USA 3 Department of Medicine, Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, NY, USA 4 Department of Cardiovascular Diseases, John Ochsner Heart & Vascular Institute, University of Queensland School of Medicine, New Orleans, LA, USA The occurrence of subclavian artery (SA) stenosis or occlusion is low compared to lower extremity disease with a prevalence of approximately 2–3% in the general population [1, 2]. Atherosclerosis is the most common cause for hemodynamically significant lesions with arteritis, and aneurysmal disease being less common. The left SA is more commonly affected than the right side, with a slight male to female predominance. Most patients are asymptomatic, and treatment is generally recommended for symptomatic patients. Symptoms that warrant intervention include vertebrobasilar insufficiency, arm claudication, and transient ischemic attacks. Less commonly, interventions are performed for protection of an arteriovenous fistula or prevention of coronary steal syndrome in patients with prior internal mammary coronary bypass surgery. Endovascular intervention for SA stenosis became the first line of treatment. Optimal treatment for SA occlusive disease has been controversial ever since the introduction of endovascular interventions [3]. Percutaneous balloon angioplasty of SA stenosis was first described in 1980 by Bachman and Kim. Since then, several studies have compared the durability of endovascular repair to the conventional open surgical repair. Open surgical repair has better long‐term patency compared to endovascular repair, 96% compared to 70% at five years, respectively [4, 5]. AbuRahma et al. showed that technical success rate was similar in both the groups, the open repair group had better long‐term patency and recurrence of symptoms compared to the endovascular group [4]. However, with the advancements in endovascular techniques in the last three decades, endovascular repair has become the first choice for SA revascularization. Several studies have shown primary patency rates of 77–93% at one year and 72–93% at three to eight years, respectively [6–9]. The technical success of treating SA lesions varies dramatically for stenosis compared to occlusions. SA occlusions especially ostial lesions are more difficult to treat compared to stenosis. Some have reported technical success ranging from 50 to 100% for occlusions compared to stenosis ranging from 91 to 100%. Jahic et al. reported 100% success rate with SA stenosis and only 55.5% success in total occlusions, respectively [10]. Step 1. Transfemoral approach is generally preferred and initiated using the Seldinger technique; however, brachial and combined femoral‐brachial access may also be used. Once access is achieved, a short or long introduction sheath is placed and a nonselective aortic arch angiogram in the left anterior oblique (LAO
2
Subclavian Artery Intervention: Catheter‐Based Therapy
Introduction
Endovascular Versus Open Surgical Revascularization
Endovascular Revascularization Techniques
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
