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Long-term results of endovascular therapy for proximal subclavian arterial obstructive lesions
Ke-qin Wang1, Zhong-gao Wang, Bao-zhong Yang
1Department of Vascular Surgery, Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
Insights
Endovascular therapy effectively treats subclavian artery blockages, showing high technical and clinical success rates. This minimally invasive approach offers a successful treatment option for patients with these obstructive lesions.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Procedures
Background:
- Localized occlusion of the subclavian artery is a condition requiring effective treatment.
- Endovascular therapy presents a viable option for managing subclavian artery obstructions.
Purpose of the Study:
- To evaluate the long-term outcomes of endovascular therapy for proximal subclavian artery obstructive lesions.
- To assess the safety and efficacy of endovascular treatment in a cohort of 59 patients.
Main Methods:
- A retrospective analysis of 59 patients (61 lesions) treated between June 1998 and September 2008.
- Procedures performed under local anesthesia using femoral or brachial artery access, with 60 stents implanted.
- Patients were monitored post-procedure at regular intervals, including annual follow-ups.
Main Results:
- High technical success rate of 95.1% (58/61 arteries stented).
- Clinical success achieved in 93.4% (55/59 patients), with significant reduction in stenosis.
- Excellent long-term patency rates (98% at 12 months, 82% at 5 years) and overall survival (84.5% at 5 years).
Conclusions:
- Endovascular therapy is a highly effective and successful treatment for proximal subclavian arterial obstructive lesions.
- This minimally invasive approach is recommended as a potential first-line treatment option.
Background:
Endovascular therapy is a treatment option for localized occlusion of the subclavian artery. In this report the long-term experience with 59 patients is presented.
Methods:
Between June 1998 and September 2008, we used endovascular therapy to treat 61 subclavian arterial obstructive lesions in 59 patients (46 males and 13 females, 34 - 82 years of age with a mean age (61.9 + or - 11.0) years). Twenty patients (34%) had clinical symptoms due to vertebrobasilar insufficiency, 26 (44%) had disabling arm ischemia, and 13 (22%) had both symptoms. We performed all procedures under local anesthesia. The approaches were from the femoral artery (n = 47), brachial artery (n = 1, involving bilateral subclavian disease) or both (n = 11). Sixty stents were implanted. All patients were followed-up at 1, 3, 6, and 12 months post-procedure, and annually thereafter.
Results:
We achieved technical success in 58 (95.1%) arteries, all of which were stented. There were three technical failures; two were due to the inability to cross over an occlusion, necessitating the switch to an axillo-axillary bypass, and the third was due to shock after digital subtraction angiography and prior to stenting. Arterial stenosis pre- and post-stenting was (83.6 + or - 10.8)% and (2.5 + or - 12.5)% (P < 0.01). Clinical success was achieved in 55 of the 59 patients (93.4%). Of the four clinical failures, three were technical and the remaining patient had a stent thrombosis. Systolic blood pressure difference between the two brachial arteries was (44.7 + or - 18.5) vs. (2.2 + or - 3.9) mmHg (P < 0.01). Primary patency was 98% at 12 months, 93% at 24 months, and 82% at 5 years. Five patients were lost to follow-up by 12 months post-stenting. Significant recurrent obstruction developed in five patients with resumption of clinical symptoms. The overall survival rate was 98.2% at 12 months, 89.5% at 24 months, and 84.5% at 5 years.
Conclusions:
Endovascular therapy for proximal subclavian arterial obstructive lesions is effective and successful. This minimally invasive treatment may be the first choice of treatment for proximal subclavical arterial obstructive lesions.
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