Abstract
Purpose: The purpose of this retrospective study was to evaluate the technical success and clinical outcomes of endovascular procedures and to compare them with the surgical procedures of subclavian artery occlusive diseases.
Material and Methods: Between 1994 and 2009, 37 patients with clinical symptoms secondary to subclavian artery stenoses and/or occlusion were diagnosed by color Doppler ultrasound (CDUS) or Digital Subtraction Angiography (DSA). 14 (37.8%) of these patients were female and 23 (62.2%) were male; mean age was 56.4 (arange 22-82). 38 lesions were treated with balon anjioplasty and/or stent placement. After treatment, patients’ follow-ups were performed by CDUS and clinically.
Results: 32 (84.2%) of lesions were found 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 the technical success rate for occlusions was 57%. 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 stent graft were used to treat these complications. In another patient, because of distal thromboembolic occlusions, 5 mg t-PA infusion for 1.5 hour was applied and recanalisation was obtained. For early (0-3 months) and mid (3-6 months) terms 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.
References
- KAYNAKLAR
- 1. AbuRahma FA, Robinson PA and Jennings TG. Carotid-subclavian bypass grafting with polytetrafluoroethylene grafts for symptomatic subclavian artery stenosis or occlusion: A 20- year experience. J Vasc Surg 2000; 32: 411-419.
- 2. Rodriguez-Lopez JA, Werner A, Martinez R, Torruella LJ, Ray LI, Diethrich EB. Stenting for atherosclerotic occlusive disease of the subclavian artery. Ann Vasc Surg 1999; 13: 254-260.
- 3. Patel SN, White JC, Collins JT, Gary A, Daniel AG, Jenkins JS, et al. Catheter-Based Treatment of the Subclavian and Innominate Arteries. Catheterization and Cardiovascular Interventions 2008; 71: 963-968.
- 4. Valji K. Vascular and Interventional Radiology, 2th Ed. California: W.B. Saunders Company, 2006.
- 5. Kadwa AM, Robbs JV. Gangrenous fingers: the tip of the iceberg. J R Coll Surg Edingb 1990; 35: 71-74.
- 6. Hüttl K, Nemes B, Simonffy A, Entz L, Berczi V. Angioplasty of the Innominate Artery in 89 Patients: Experience over 19 Years. Cardiovasc Intervent Radiol 2002; 25: 109-114.
- 7. Schillinger M, Haumer M, Schillinger S. Risk stratification for subclavian artery angioplasty: Is there an increased rate of restenosis after stent implantation? J Endovasc Ther 2001; 8: 550-557.
- 8. Staikov IN, Do DD, Remonda L, Mattle H, Baumgartner R, Schroth G. The site of atheromatosis in the subclavian and vertebral arteries and its implication for angioplasty. Neuroradiology 1999; 41: 537-542.
- 9. Henry M, Amor M, Henry I, Ethevenot G, Tzvetanov K, Chati Z. Percutaneous transluminal angioplasty of the subclavian arteries. J Endovasc Surg 1999; 6: 33-41.
- 10. Kumar K, Dorros G, Bates MC, Palmer L, Mathiak L, Dufek C. Primary stent deployment in occlusive subclavian artery disease. Cathet Cardiovasc Diagn 1995; 34: 281-285.
- 11. Brountzos EN, Petersen B, Binkert C, Panagiotou I, Kaufman JA. Primary stenting of subclavian and innominate artery occlusive disease: A single center’s experience. Cardiovasc Intervent Radiol 2004; 27: 616-623.
- 12. Cina CS, Safar HA, Lagana A, Arena G, Clase CM. Subclavian carotid tranposition and bypass grafting, consecutive cohort study and systemic review. J Vasc Surg 2002; 35: 422-429.
- 13. Sixt S, Rastan A, Schwarzwalder U. Results After Balloon Angioplasty or Stenting of Atherosclerotic Subclavian Artery Obstruction. Catheterization and Cardiovascular Interventions 2009; 73: 395-403.
- 14. Law MM, Colburn MD, Moore WS, Quinones-Baldrich WJ, Machleder HI, Gelabert HA. Carotid-subclavian bypass for brachiocephalic occlusive disease. Stroke 1995; 26: 1565-571.
- 15. De Vries JP, Jager LC, Van den Berg JC. Durability of percutaneous transluminal angioplasty for obstructive lesions of proximal subclavian artery: Long-term results. J Vasc Surg 2005; 41: 19-23.
Abstract
Amaç: Bu retrospektif çalışmanın amacı, subklavyen arter
tıkayıcı hastalıklarında endovasküler tedavinin başarısını ve klinik
sonuçlarını değerlendirmek ve bu sonuçları cerrahi tedavi yöntemleri ile
karşılaştırmaktır.
Gereç ve Yöntem: 1994-2009 yılları arasında mevcut klinik
semptomları ile görüntüleme yöntemleri renkli Doppler ultrasonografi
(RDUS), Dijital Subtraksiyon Anjiyografi (DSA) sonrasında subklavyen arter
stenozu ve/veya oklüzyonu saptanan 14’ü (%37,8) kadın, 23’ü (%62,2) erkek olan
ve yaşları ortalama 56,4 (22 ile 82 yıl arasında değişen) 37 hastada mevcut 38
lezyona balon anjiyoplasti ve/veya stent implantasyonu ile endovasküler tedavi
uygulandı. Tedavi sonrasında hastaların kontrolleri önceden planlanmış sürelerde
klinik ve RDUS ile takipleri yapıldı.
Bulgular: Lezyonların 32’si sol (%84,2), 6’sı sağ (%15,8)
yerleşimliydi. Olguların 7’si (%18,4) oklüzyon, 31’i (%81,6) stenoz idi. Stenoz
oranı RDUS’de %50’den fazla, DSA’da ise ortalama %83,2 idi. Stenotik lezyonlar
için teknik başarı %100 idi. Oklüde olan 3 lezyon geçilemediği için bu
hastalara endovasküler tedavi yapılamadı. Bu nedenle oklüzyonlar için teknik
başarı %57 idi. Komplikasyon olarak işlem sırasında bir hastada ekstravazasyon
ve subklavyen arter proksimalinde trombotik oklüzyon gelişmesi üzerine
ekstravazasyon mevcut segmente stent greft ve proksimaldeki oklüzyona ayrı bir
stent implantasyonu yapıldı. Bir hastada ise distal embolizasyon gelişmesi
üzerine 1,5 saat boyunca 5 mg t-PA infüzyonu yapıldı ve rekanalizasyon
sağlandı. Takibi yapılabilen hastalarda erken (0-3 ay) ve orta (3-6 ay) dönem
için primer ve sekonder patensi oranı %100 iken geç (6-12 ay) dönem için primer
patensi %95,5, sekonder patensi ise %100 olarak bulundu.
Sonuç: Subklavyen arter tıkayıcı hastalıklarında
endovasküler tedavi teknik ve klinik olarak cerrahi tedaviye alternatif etkin
ve güvenli bir yöntemdir.
References
- KAYNAKLAR
- 1. AbuRahma FA, Robinson PA and Jennings TG. Carotid-subclavian bypass grafting with polytetrafluoroethylene grafts for symptomatic subclavian artery stenosis or occlusion: A 20- year experience. J Vasc Surg 2000; 32: 411-419.
- 2. Rodriguez-Lopez JA, Werner A, Martinez R, Torruella LJ, Ray LI, Diethrich EB. Stenting for atherosclerotic occlusive disease of the subclavian artery. Ann Vasc Surg 1999; 13: 254-260.
- 3. Patel SN, White JC, Collins JT, Gary A, Daniel AG, Jenkins JS, et al. Catheter-Based Treatment of the Subclavian and Innominate Arteries. Catheterization and Cardiovascular Interventions 2008; 71: 963-968.
- 4. Valji K. Vascular and Interventional Radiology, 2th Ed. California: W.B. Saunders Company, 2006.
- 5. Kadwa AM, Robbs JV. Gangrenous fingers: the tip of the iceberg. J R Coll Surg Edingb 1990; 35: 71-74.
- 6. Hüttl K, Nemes B, Simonffy A, Entz L, Berczi V. Angioplasty of the Innominate Artery in 89 Patients: Experience over 19 Years. Cardiovasc Intervent Radiol 2002; 25: 109-114.
- 7. Schillinger M, Haumer M, Schillinger S. Risk stratification for subclavian artery angioplasty: Is there an increased rate of restenosis after stent implantation? J Endovasc Ther 2001; 8: 550-557.
- 8. Staikov IN, Do DD, Remonda L, Mattle H, Baumgartner R, Schroth G. The site of atheromatosis in the subclavian and vertebral arteries and its implication for angioplasty. Neuroradiology 1999; 41: 537-542.
- 9. Henry M, Amor M, Henry I, Ethevenot G, Tzvetanov K, Chati Z. Percutaneous transluminal angioplasty of the subclavian arteries. J Endovasc Surg 1999; 6: 33-41.
- 10. Kumar K, Dorros G, Bates MC, Palmer L, Mathiak L, Dufek C. Primary stent deployment in occlusive subclavian artery disease. Cathet Cardiovasc Diagn 1995; 34: 281-285.
- 11. Brountzos EN, Petersen B, Binkert C, Panagiotou I, Kaufman JA. Primary stenting of subclavian and innominate artery occlusive disease: A single center’s experience. Cardiovasc Intervent Radiol 2004; 27: 616-623.
- 12. Cina CS, Safar HA, Lagana A, Arena G, Clase CM. Subclavian carotid tranposition and bypass grafting, consecutive cohort study and systemic review. J Vasc Surg 2002; 35: 422-429.
- 13. Sixt S, Rastan A, Schwarzwalder U. Results After Balloon Angioplasty or Stenting of Atherosclerotic Subclavian Artery Obstruction. Catheterization and Cardiovascular Interventions 2009; 73: 395-403.
- 14. Law MM, Colburn MD, Moore WS, Quinones-Baldrich WJ, Machleder HI, Gelabert HA. Carotid-subclavian bypass for brachiocephalic occlusive disease. Stroke 1995; 26: 1565-571.
- 15. De Vries JP, Jager LC, Van den Berg JC. Durability of percutaneous transluminal angioplasty for obstructive lesions of proximal subclavian artery: Long-term results. J Vasc Surg 2005; 41: 19-23.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Radiology and Organ Imaging |
| Journal Section | Research |
| Authors | |
| Publication Date | June 30, 2019 |
| Acceptance Date | October 6, 2018 |
| Published in Issue | Year 2019 Volume: 44 Issue: 2 |
