Purpose
Lesion of the subclavian/innominate artery is an important cause of extracranial cerebrovascular disease (1).
Symptomatic patients present with upper limb ischemia,
ischemia of the posterior cerebral circulation or both.
In case of innominate artery lesion ischemia of the anterior cerebral circulation can also occur (2).
Patients with isolated subclavian artery lesions are often asymptomatic because of the presence of rich collateral supply (2).
Innominate artery lesions are uncommon and represent small portion of aortic arch lesions.
The left subclavian artery is involved more often than...
Methods and Materials
From February 2006 to January 2012,
46 lesions of the subclavian and innominate arteries were endovascularly treated in 46 patients (24 men [52,2%] and 22 women [47,8%]; mean age at intervention,
62 years [range,
45 to 74 years]).
All patients were symptomatic: 20 (43,5%) had vertebrobasilar ischemia,
17 (37,0%) had upper limb ischemia and 9 (19,6%) had both.
Thirty-seven stenoses (80,5%) and 9 occlusions (19,5%) were treated.Descriptive data on the patient cohort are listed in Table 1.Lesions were classified in 4 categories according to the...
Results
Initial technical success was achieved in 42 (91,3%) of 46 procedures.
Four initial failures were due to inability to cross total occlusions.
That means that technical success in first and second group was 100% and 77%,
respectively.
The difference is statistically significant (Fischer's exact test; p=0,019).
Complications occurred in 5 of 46 procedures (10,9%).
Three access-site complications were hematomas (2 femoral and 1 brachial) and did not require operative repair.
Remaining 2 complications were embolisations from innominate artery to ipsilateral internal carotid artery and from...
Conclusion
The first reports of surgical treatment of aortic arch branches were published in 1950s (14,
15).
Although the functional results of these procedures were satisfactory,
the operative mortality rate was exceedingly high (14).
Because of the risks of transthoracic procedures,
extra-anatomic (carotid-subclavian) bypass grafting was introduced in the late 1960s (16).Their good results and low mortality were confirmed by later studies (17,
18).
PTA of the aortic arch branches was introduced in 1980 by Mathias et al and Bachman and Kim,
and has subsequently evolved...
References
1.
Fields WS,
Lemak NA.
Joint study of extracranial arterial occlusion.
Subclavian steal: a review of 168 cases.
JAMA 1972; 222:1139-43.
2.
Brountzos EN,
Malagari K,
Kelekis DA.
Quality assurance guidelines for the endovascular treatment of occlusive lesions of the subclavian and innominate arteries.
Dunaj; Quality Improvement Guidelines: 2010.
Available at: http://www.cirse.org.
3.
Wilms G,
Baert A,
Dewaele D,
Vermylen J,
Nevelsteen A,
Suy R.
Percutaneous transluminal angioplasty of the subclavian artery: early and late results.
Cardiovasc Intervent Radiol 1987; 10:123-128.
4.
Mathias K,
Schlosser...
Personal Information
Beno Polanec MD,
Department of Radiology,
UKC Maribor;
[email protected]
Silva BreznikMD,
Department of Radiology,
UKC Maribor;
[email protected]
Aleš SlaničMD,
Department of Radiology,
UKC Maribor;
[email protected]
Jernej LučevMD,
Department of Radiology,
UKC Maribor;
[email protected]
Jožef Matela PhD,Department of Radiology,
UKC Maribor;
[email protected]
