Endovascular treatment of subclavian artery occlusive diseases

Purpose: In the treatment of subclavian artery occlusive diseases, major complication rate is less than surgery and the procedure itself is less invasive. Although the patency and technical success rates between endovascular and surgical procedures are similar, because of the technological develompment, endovascular procedure has become more preferable procedure recently. The purpose of this study is to evaluate the technical success and clinical outcomes of endovascular procedure and to compare them with the surgical procedures in subclavian artery occlusive diseases.Material and Methods: Between 1994 and 2009, 37 patients with clinical symptoms were applied to hospital and found subclavian artery stenoses and/or occlusion by radiological imaging modalities (Doppler US, DSA). 14 (37.8%) of these patients were female and 23 (62.2%) were male; mean age was 56.4 (22-82). 38 lesions were treated with PTA and/or stent. After treatment, patients follow up was scheduled on 1. day, 1, 3, 6, 12. months and per year afterwards by Doppler US and clinical findings.Results: 32 (84.2%) of these lesions were on the left and 6 (15.8%) were on the right side. Technical success rate for stenotic lesions was 100%. We couldn?t achieve to pass through 3 occlusions and so that the technical success rate for occlusions was 70% (7/10). As a complication, in one patient, during the procedure, thrombotic occlusion in the proximal segment of subclavian artery and extravasation in the mid segment were encountered. Another stent and a stentgreft were used to treat these complications. In another patient, because of distal thrombotic embolisation, 5 mg t-PA infusion for 1.5 hour was applied and partial recanalisation was obtained. For early (0-3 months) and mid (3-6 months) term primary and secondary patency rate was 100%. We found primary patency rate 95.5% and secondary patency rate 100% for late term (6-12 months).Conclusion: Endovascular treatment of subclavian artery occlusive diseases is, technically and clinically, effective and safe procedure and alternative to surgery.Keywords: Subclavian artery, endovascular treatment, stent, balloon angioplasty, stenosis, occlusion.