Endovascular Treatment in the Subclavian Steal Syndrome

When the proximal occlusion or stenosis of the subclavian or of the brachiocephalic artery may require distal arterial filling through reversal flow from the vertebral artery, causing clinically significant blood supply reduction to the brainstem, it is called subclavian steal syndrome (SSS). We report a 54-year-old male patient who presented with multiple episodes of syncopes and vascular claudication due to right SSS. He underwent an angioplasty, evolving with complete improvement of the symptoms. We review the clinical presentation, the diagnosticmethods, and the treatment options of the disease.

Subclavian artery steal syndrome patients with interventional therapy / 局解手术学杂志

Objective To explore the feasibility and effect of intervention therapy for patients subclavian steal syndrome.MethodsThe data of 35 patients with subclavian artery steal syndrome in neurology department of our hospital from October 2014 to March 2016 were retrospectively analyzed.All patients treated with pecutaneous transtuminl angioplasty and stenting.The degree of vascular stenosis was measured by digital subtraction angiography, the inter-arm blood pressure was tested by mercury sphygmomanometer.And the clinical manifestations before and after surgery were compared.All patients were followed up for 1 to 12 months,the clinical manifestations,blood flow and vascular stenosis degree in patients were observed.Results All patients were finished pecutaneous transtuminl angioplasty and stenting successfully,7 patients with serious vascular stenosis treated with percutaneous intravascular balloon dilatation at first.The average artery stenosis before operation was(74.73±10.42)%,while it decreased to(8.60+3.16)% after surgery,which were measured by DSA,the difference was significant(P<0.01).The result from mercury sphygmomanometer showed that the inter-arm blood pressure from preoperative(44.43±10.12)mmHg to postoperative (10.09+4.80)mmHg (2~7 days),systolic blood pressure differential minified significantly,the difference was significant(P<0.01).All patients were followed up for 1 to 12 months,support forms of 34 cases were in good conditions without new narrow,1 case appeared narrow in postoperative 7 months,then recovered after reoperation;symptoms of 28 cases significantly improved or disappeared,5 cases partly alleviated,2 cases had recurrence,no serious complications such as thrombosis and severe infarction occurred.Conclusion The pecutaneous transtuminl angioplasty and stenting is stable,high successful and low short-term recurrence rate for subclavian steal syndrome,which is good to alleviate vascular stenosis,reduce interrm blood pressure difference and improve clinical manifestation.

Iatrogenic Subclavian Artery Perforation Rescued by Operator-Modified Graft Stent

Subclavian artery (SCA) perforation is a rare complication while performing SCA intervention. In our present report, a 73-year-old female, with stenosis of the left SCA and situs inversus, presented with exercise-induced left arm weakness. The SCA stenosis was treated with direct stenting with a balloon-expansible Express LD 10×25 mm stent. However, it caused iatrogenic SCA perforation and hemothorax. The perforation was sealed by endovascular repair with operator-modified Endurant II graft stent, which complicated with occlusion of left common carotid artery. And, the carotid artery was rescued by another stent. The graft stent, which was originally designed for abdominal aortic aneurysm, can be modified to suitable length and take as a rescue stent of large vessel with iatrogenic perforation. Due to strong radial force of graft stent, preservation of large side branches should been watched out.

Perioperative intra‑aortic balloon counterpulsation in a patient with myocardium at risk undergoing urgent noncardiac surgery.

We are presenting the case of a 76‑year‑old female scheduled for major abdominal surgery. Her past medical history was remarkable for a three‑vessel coronary artery disease, with a severely impaired left ventricular function. She had already undergone complex coronary artery bypass surgery. Currently, she presented with the rare constellation of a hemodynamic relevant and interventionally intractable stenosis of the left subclavian artery proximal to a crucial coronary bypass from left internal mammary artery to the left anterior descending. To protect this patient from perioperative myocardial infarction, an intra‑aortic balloon pump was successfully used.

Patent Coronary Artery Bypass Graft (CABG) is not Sufficient for Myocardial Perfusion: Non-ST Elevation Myocardial Infarction Caused by Critical Subclavian Artery Stenosis

Myocardial revascularization using the left internal thoracic artery (LITA) has become a standard method for coronary artery bypass graft (CABG) surgery due to its long-term graft patency and lower repeated revascularization rate compared to a saphenous vein graft. The prevalence of significant subclavian artery stenosis was reported to be 0.2-6.8% in patients undergoing CABG surgery using LITA. We present a case of 49-year-old female patient who complained of resting chest pain and left arm pain after CABG surgery using the LITA. NSTEMI was caused by de novo subtotal left subclavian artery stenosis proximal to the LITA. The left subclavian artery was successfully stented, and the patient experienced complete relief of pain.

Carotid-axillary Bypass for Subclavian Atery Occlusion with Gaining Access through the Axillary Fossa: Report of One Case

Some representative operative techniques have been introduced for treating subclavian artery stenosis or occlusion: carotid-subclavian bypass, carotid-subclavian interposition and axillo-axillary bypass. But the cases of carotid-axillary bypass are rare and moreover, carotid-axillary bypass with gaining access through the axillary fossa are rare in the medical literature. A 77-year-old man who had left upper arm claudication that was aggravated when he performed some hand movements like buttoning-up or undoing buttons visited our hospital. The upper extremity computed tomography angiography showed a 4-centemeter-long occlusion of the left subclavian artery, which began at the point passed by the bulb of the vertebral artery. We performed carotid-axillary bypass between the left axillary artery at the axillary fossa and the left common carotid artery at the left neck at the anterior aspect of the sternocleidomastoid muscle. This operation could be a feasible alternative modality for a patient with occlusion of a long distal segment of the subclavian artery.

Left subclavian artery stenosis found by the interarm blood pressure difference during combined spinal-epidural anesthesia of patient with peripheral vascular disease: A case report / 대한마취과학회지

In spite of the American Heart Association recommendations for blood pressure measurement, many physicians measure blood pressure in only one arm that is easy to access at the time of measurement. This practice can lead to incorrect management with significant interarm blood pressure difference. We report a case of a 51 years old man who was scheduled to undergo vascular bypass graft under combined spinal-epidural anesthesia. In 60 minutes after anesthesia, the blood pressure of left arm dropped from 110/65 mmHg to 74/45 mmHg. The blood pressure was still 80/50 mmHg after two injections of ephedrine. After checking radial pulse tone strength, we found significant interarm blood pressure difference. The blood pressure of right arm was 150/70 mmHg. Postoperative CT angiogram revealed significant stenotic portion in the left subclavian artery. This case emphasizes the importance of bilateral blood pressure measurement, especially in patients with peripheral vascular disease.

Late-onset Brachial Artery Occlusion caused by Subclavian Artery Stenosis after Clavicular Fracture: A Case Report

Although vascular injury after clavicular fracture is a extremely rare, it is a complication which is serious problem. Vascular injury associated with the fracture can be immediate or delayed. We report a case of late-onset brachial artery occlusion caused by subclavian artery stenosis with excessive scar tissue after open reduction and plate fixation for clavicular fracture and include a review of the literature.

Subclavian artery stenosis in neurofibromatosis type 1 / 대한내과학회지

Vascular involvement in neurofibromatosis type 1 (NF1) is a well known but clinically underestimated phenomenon. Arterial stenosis and aneurysm have been reported and among the stenotic vasculopathy, renal artery stenosis is the most common type. On PubMed search, there have been 9 reported cases of subclavian arterial involvement in NF1, of which only one case showed subclavian arterial stenosis. We report a 41-year-old man with NF1 and a subclavian artery stenosis who was treated successfully with percutaneous transluminal angioplasty.

Interventional management in 20 patients with subclavian artery stenosis:follow-up results / 中国介入心脏病学杂志

Objective To describe our follow-up results of interventional management in 20 patients with subclavian artery stenosis. Methods This study involved in 20 symptomatic patients with an average age of 63.4 years,a mean stenose severity of 86.2% and a mean systolic arterial pressure difference of 116 mm?Hg between both upper limbs. Percutaneous transluminal angioplasty (PTA) in the first 8 patients and stenting in the last 12 patients were performed via a right femoral or radial artery. Results Both PTA and stenting were successfully archived in all patients with normalization of radial pulses and a mean systolic arterial pressure difference of 24 mm?Hg between both upper limbs. No major complications occurred. In the follow-up for an average of 18.5 months,19 patients were free of adverse events except one with symptom recurrence. Conclusion As effective,simple and safe procedures,PTA and stenting can be used as a first-line treatment modality for the symptomatic patients with subclavian artery stenosis.

Early Results of Subclavian Artery Stenting

BACKGROUND AND OBJECTIVES: Though the surgical intervention of subclavian artery stenosis has been effective, its high morbidity and mortality have limited its clinical application. In 1980 percutaneous balloon angioplasty of stenotic artery was introduced as a substitute for surgical intervention and subsequent reports have supported its efficacy noting that it is more effective when combined with stent. The purpose of this study was to assess the feasibility, safety, and efficacy of percutaneous intervention as an alternative or primary therapy for symptomatic subclavian artery stenosis. METHODS: Between September 1993 and October 1998, 17 lesions in 16 patients of symptomatic subclavian artery stenosis were enrolled as candidates for nonsurgical intervention. We performed percutaneous balloon angioplasty with stenting to the subclavian artery stenosis and evaluated the early results. RESULTS: 1)The patients had a mean age of 55+/-14 years and 13 of 16 patients were male. 2)Subclavian artery stenting was successful in 94% (16/17) of the lesion without significant complications. The cause of failure was suboptimal result after deployment of stent. 3)The types of stents deployed were Strecker stents in 4, Palmaz stents in 8, Wall stents in 3 and Jo stents in 2 cases. 4)The peak and mean pressure gradient reduced from 58.5+/-17.0 to 8.5+/-7.4 and 31.4+/-13.0 to 4.7+/-5.5 mmHg respectively (p<0.01) and the degree of luminal stenosis decreased from 92.5+/-8.5% to 10.0+/-14.3%. (p<0.01) CONCLUSION: Subclavian artery stenosis can be managed safely and effectively through percutaneous balloon angioplasty with stenting, with an excellent technical success rate and less morbidity and mortality particularly in patients coexisting other vascular and systemic diseases. However, the long-term patency and clinical effects should be warranted.

Subclavian Artery Stenosis and Malfunction of Axillobifemoral Bypass Graft: A case report

Though axillo-femoral bypass has been the preferred procedure since the introduction of the procedure by Blaisdell1) in 1963 for high risk patients who have aorto-iliac occlusive disease, widespread use of axillo-femoral bypass was limited in the past because long-term patency rates were inferior to aortofemoral bypass. Multiple mechanisms were mentioned for its inferior patency but delayed stenosis of the inflow artery(not at anastomosis site) were not reported frequently. The authors experienced one case of inflow malfunction of axillo-femoral bypass due to subclavian artery stenosis in a patient with coronary artery disease and carotid artery stenosis. Subclavian artery stenosis was treated by percutaneous transfemoral angioplasty with improvement of symptom and ABI.