2Imtinene Ben Mrad, 2Rim Miri, 2Sobhi Mleyhi, 2Bilel Derbel, 2Melek Ben Mrad, 1Ihsen Zairi, 1Zeineb Oumaya, 1Khadija Mzoughi, 1Sondos Kraiem

1Cardiology Department, Hbibthameur Hospital, Tunis, Tunisia; 2Rabta Hospital, medical university of tunis, Tunis El Manar university, Tunis, Tunisia

Background:

To evaluate the results of endovascular therapy for steno-occlusive lesions of subclavian artery (SA) over the medium and long term, through our experience and the ones reported in current literature.

Material(s) and Method(s):

Data about consecutive patients treated for subclavian artery steno-occlusive disease between 2013 and 2018 by endovascular repair (ER) were retrospectively collected and analyzed. Primary outcomes included 30- day death, as well as cardiac and neurologic events was analysed. Secondary outcomes included primary patency in the long term.

Result(s):

40 patients were included. The mean age was 61 years (range, 37-89), and 57.5% were males. procedures were performed via radial (6-7 Fr) access in 28 cases (82%) and surgical brachial access in six cases (18%).

Percutaneous trans angioplasty (PTA) with stent implantation was performed in 31 cases (77,5%), using balloon expandable stents. Three cases (7,5%) was treated with simple balloon angioplasty. Technical success rate was 85% (34 patients); 90% in case of stenosis and 73% in case of occlusions. Symptoms resolution and upper limb salvage were 100%. periprocedural complication rate was relatively low (4.4%), limited to two cases of hematoma at the access site recovered spontaneously and one case of stent thrombosis occurred at one month. The median follow-up was 23 months (range 12-48 months). Two in-stent restenosis were reported through the follow-up (At 13 and 16 months) in two patients with Takayasu disease and were treated with drug eluting balloon angioplasty with favorable outcomes. A case of late stent thrombosis occurred in the 12th month in a patient who had initially been treated for SA occlusion and needed a surgical revascularization by carotid-axillary bypass. Late mortality rate was 0%. Primary patency was respectively 97%, 83%, 83% and 83% at the 1st, 2nd, 3rd and 4th year. Data about consecutive patients treated for subclavian artery steno-occlusive disease between 2013 and 2018 by endovascular repair (ER) were retrospectively collected and analyzed. Primary outcomes included 30- day death, as well as cardiac and neurologic events was analysed. Secondary outcomes included primary patency in the long term.

40 patients were included. The mean age was 61 years (range, 37-89), and 57.5% were males. procedures were performed via radial (6-7 Fr) access in 28 cases (82%) and surgical brachial access in six cases (18%).

Percutaneous trans angioplasty (PTA) with stent implantation was performed in 31 cases (77,5%), using balloon expandable stents. Three cases (7,5%) was treated with simple balloon angioplasty. Technical success rate was 85% (34 patients); 90% in case of stenosis and 73% in case of occlusions. Symptoms resolution and upper limb salvage were 100%. periprocedural complication rate was relatively low (4.4%), limited to two cases of hematoma at the access site recovered spontaneously and one case of stent thrombosis occurred at one month. The median follow-up was 23 months (range 12-48 months). Two in-stent restenosis were reported through the follow-up (At 13 and 16 months) in two patients with Takayasu disease and were treated with drug eluting balloon angioplasty with favorable outcomes. A case of late stent thrombosis occurred in the 12th month in a patient who had initially been treated for SA occlusion and needed a surgical revascularization by carotid-axillary bypass. Late mortality rate was 0%.

Primary patency was respectively 97%, 83%, 83% and 83% at the 1st, 2nd, 3rd and 4th year.

Conclusion(s):

The present study shows that endovascular therapy of steno-occlusive SA was associated with high technical and clinical success rates, low complication rates, and good long-term patency rate.