Percutaneous Transluminal Angioplasty of the Subclavian Arteries

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.