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Rivista di Angiologia
Official Journal of the , the International Union of Phlebology and the
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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International Angiology 2007 December;26(4):324-40
Percutaneous transluminal angioplasty of the subclavian arteries
Henry M. 1,2, Henry I. 3, Polydorou A. 4, Polydorou Ad. 5, Hugel M. 1,2
1 Private Practice,Cardiology, Nancy, France
2 Global Research Institut, Apollo Hospital Complex, Hyderabad, India
3 Bois Bernard Polyclinic, Bois Bernard, France
4 Pantaleimon General Hospital, Athens, Greece
5 Alexander S. Onassis Public Benefit Foundation, Athens, Greece
Aim. The aim of this study was to review the feasibility, safety and long-term results of subclavian artery (SA) angioplasty.
Methods. Over 14 years, 237 patients (males: 135; mean age: 64±12 years) underwent percutaneous treatment for SA occlusive disease. Indications for treatment were upper limb ischemia (n=125), vertebrobasilar insufficiency (n=128), coronary steal (n=11) and anticipated coronary bypass surgery in asymptomatic patients (n=26). A total of 192 arteries were stenosed and 45 occluded. Mean percentage stenosis was 81.9±7.6% and mean lesion length was 23.8±8.8 mm. Percutaneous techniques included retrograde femoral (n=163), brachial artery (n=47) access or both (n=14) and in 4 cases the “pull through technique”. An isolated balloon angioplasty was performed in 59 cases. We implanted 132 balloon expandable stents and 32 self-expandable stents.
Results. Technical success was obtained in 223 lesions (94%). Only 31 occlusions were recanalized (69%). Four periprocedural events occurred (1.2%), 1 major (fatal) stroke, 1 transient ischemic attack and 2 arterial thromboses. At follow-up (mean follow-up: 65.8±33.5 months), we had 27 restenoses (12%). Thirteen occurred following angioplasty alone (18.8%) and 14 following angioplasty and stent implantation (8.4%). Primary (PI) and secondary (PII) patencies on an intention to treat basis at 10-year follow-up were 78.1% and 84.5%, respectively. In patients without initial stent placement, the rates were 67.5% and 75.5%, while in those with stents the rates rose to 89.7% and 96.9% (P<0.01). PI for all recanalized lesions were 84.6%, 79.1% without stent, 89.7% with stent (P<0.04) and PII 91.6%, 88.5%, 96.9%, respectively (P<0.02).
Conclusion. Percutaneous transluminal angioplasty is currently the treatment of choice for SA lesions. It is a safe and effective procedure associated with low risks and good long-term results. Stents seem to limit the restenosis rate and improve long-term results.