Deliberate subclavian artery occlusion during aortic endovascular repair: is it really that safe?

To report a series of cases in which deliberate occlusion of the left Subclavian Artery (SA) caused the Subclavian Steal Syndrome (SSS).

Between January 2001 and August 2006, we performed 81 endovascular repairs of the Thoracic Aorta. 21 patients required left SA occlusion for an adequate proximal landing zone. 17 of these patients were treated by deliberate SA occlusion. Four patients (23.5%) developed a SSS, of which three were treated by a secondary Subclavian-to-carotid transposition, with complete remission of the SSS.

The subclavian-to-carotid transposition was successful in the treatment of the 3 patients selected. One patient refused to be operated, and had only partial remission of the SSS symptoms. Mean follow-up was 28 months (range 2-48).

In this series deliberate occlusion of the SA led to SSS in a significant number of patients. Consideration should be given to primary subclavian transposition in some patients requiring subclavian occlusion.