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PTA of the subclavian and innominate arteries: long-term results
M Körner1, I Baumgartner, D D Do
1Department of Internal Medicine, University Hospital Berne, Switzerland.
Insights
Percutaneous transluminal angioplasty (PTA) for subclavian and innominate arteries offers a viable surgical alternative. A novel double balloon technique may reduce cerebrovascular complications in high-risk patients.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Vascular Medicine
Background:
- Subclavian and innominate artery occlusive disease presents significant clinical challenges.
- Percutaneous transluminal angioplasty (PTA) is an established endovascular treatment option.
- Evaluating long-term outcomes and safety of PTA is crucial for clinical decision-making.
Purpose of the Study:
- To assess the long-term clinical and duplex sonographic results of PTA for subclavian and innominate arteries.
- To evaluate the efficacy of a novel double balloon technique in preventing cerebrovascular thromboembolism.
- To determine the cumulative patency rates following PTA.
Main Methods:
- Retrospective analysis of 43 PTAs performed on 37 patients with subclavian or innominate artery disease.
- Application of a double balloon technique in three high-risk cases.
- Long-term follow-up including duplex sonography and life-table analysis for patency rates.
Main Results:
- Technical success rate of 84% for PTA procedures.
- Cerebrovascular thromboembolism occurred in 9% of cases, but none with the double balloon technique.
- A secondary cumulative patency rate of 72% at 100 months was observed, with restenosis primarily within 24 months.
Conclusions:
- PTA is a safe and effective alternative to surgery for subclavian and innominate artery disease.
- The double balloon technique shows promise in mitigating cerebrovascular complications.
- Long-term patency rates are comparable to existing literature, supporting PTA as a durable treatment option.
Background:
To investigate the long-term clinical and duplex sonographic results of percutaneous transluminal angioplasty (PTA) of the subclavian and innominate arteries, and the potential of a new double balloon technique to avoid cerebrovascular thromboembolism.
Patients And Methods:
Forty-three PTAs were performed on 38 subclavian, four innominate arteries and one subclavian-subclavian bypass in 37 patients. In three instances a protective double balloon technique was used. Indication for the intervention was: subclavian steal syndrome (n = 14 [38%]), upper extremity arterial insufficiency (n = 26 [70%]), peripheral thromboembolism (n = 8 [22%]) and PRIND/stroke (n = 3 [8%]). Analysis of long-term follow-up (median 15, range 2 to 100 months) was possible of 28 patients including duplex sonographic assessment in 23 patients. The cumulative patency rate was calculated by means of life-table analysis.
Results:
Technical success was achieved in 36 endovascular procedures (84%). Minor peripheral catheter complications occurred in three interventions (7%), cerebrovascular thromboembolism in four (9%). No cerebrovascular complications were seen using the double balloon technique. On final check-up 4 patients (14%) suffered from subclavian steal syndrome, 3 (11%) from mild upper extremity arterial insufficiency and one (4%) from rest pain. Duplex sonography showed no stenosis in 12 of 23 patients (52%) and a stenosis of less than 50% in 8 (35%). The life-table analysis showed a secondary cumulative patency rate of 72% after 100 months with all restenoses occurring within 24 months.
Conclusions:
PTA of the subclavian and innominate arteries appears to be a useful alternative to surgery with a low complication rate. The long-term patency rate of 72% is comparable to results of other series. In high risk situations cerebrovascular complications may be reduced using the new double balloon technique.