Subclavian steal syndrome – surgical or endovascular treatment

  • Vladimir Z Cvetić Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Momčilo Čolić Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Oliver Radmili Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Igor Banzić Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • igor Končar Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Borivoje Lukić Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Lazar Davidović Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Keywords: subclavian artery, subclavian steal syndrome, angioplasty, stents, blood vessel prosthesis, endovascular procedures, vascular procedures, operative,

Abstract


Background/Aim. A phenomenon of subclavian steal is caused by occlusion or stenosis of the proximal subclavian artery with subsequent retrograde filling of the subclavian artery via the ipsilateral vertebral artery. The aim of this research was to compare surgical method [carotid-subclavian bypass grafts (CSBG)] and endovascular methods [percutaneous transluminal angioplasty (PTA) and stenting of subclavian artery] from the aspect of immediate and long-term results. Methods. Thirty patients [16 (53.33%) males], of average age between 60.1 ± 8.25 years were treated with CSBG and compared with a group of forty patients [18 (45%) males], of the average age between  57.75 ± 6.15 years treated by PTA and stenting of subclavian artery. Immediate and long-term results were determined clinically and confirmed by Doppler pressures and duplex ultrasound/angiography. All patients were followed-up after 1, 6 and 12 months post-procedure, and annually thereafter. Results. The average follow-up for both groups was 22.37 ± 11.95 months. There were 2 (6.67%) procedural complications in the CSBG group (transient ischemic attack in 2 patients) and 3 (7.5%) ones in the PTA/stent group (dissection and distal embolization in one patient and puncture site hematoma in one patient). Systolic blood pressure difference between the two brachial arteries in CSBG group was: 42.6 ± 14.5 mmHg vs 4.75 ± 12.94 mmHg (p < 0.05). In the PTA/stent group it was: 41.2 ± 15.35 mmHg vs 3.58 ± 5.83 mmHg (p < 0.05). Long-term success was 93.33% in the CSBG group and 92.5% in the PTA/stent group (p > 0.05). Conclusions. Both, the CSBG and PTA/stenting of subclavian artery are safe, efficacious and durable procedures. They have similar immediate and long-term results. PTA and stenting are the methods of choice for high grade stenosis, near total occlusions and segment occlusions of subclavian artery. CSBG is indicated in case of diffuse occlusive lesions and when the PTA and stenting do not succeed or cause complications.

References

Contorni L. Il circolo collateralevertebro-vertebrale nell'oblit-erazione dell'arteria subclavia alla sua origine. Minerva Chir 1960; 15: 268−71.

Reivich M, Holling HE, Roberts B, Toole JF. Reversal of blood flow through vertebral artery and it's effects on cerebral circu-lation. N Engl J Med 1961; 265: 878−85.

Fisher CM. A new vascular syndrome, "the subclavian steal". N Engl J Med 1961; 265: 912−3.

Salenius J, Uurto I. Subclavian steal syndrome. Duodecim 2011; 127(20): 2148−54.

Hebrang A, Maskovic J, Tomac B. Percutaneous transluminal an-gioplasty of the subclavian arteries: Long-term results in 52 patients. AJR Am J Roentgenol 1991; 156(5): 1091−4.

Henry M, Henry I, Polydorou A, Hugel M. Percutaneous translu-minal angioplasty of the subclavian arteries. Int Angiol 2007; 26(4): 324−40.

Perler BA, Williams GM. Carotid-subclavian bypass: A decade of experience. J Vasc Surg 1990; 12(6): 716−22.

Debakey ME, Morris GL, Jordan CL, Cooley DA. Segmental thrombo-obliterative disease of branches of the aortic arch. JAMA 1958; 166: 988−1003.

Parrott JC. The subclavian steal syndrome. Arch Surg 1964; 88(4): 661−5.

Dietrich EB, Koopot R. Simplified operative procedure for prox-imal subclavian arterial lesions: Direct subclavian carotid anas-tomosis. Am J Surg. 1981; 142(3): 416−21.

Aburahma AF, Robinson PA, Jenings TG. Carotid-subclavian by-pass grafting with polytetrafluoroethylene grafts for sympto-matic subclavian artery stenosis or occlusion: A 20-year expe-rience. J Vasc Surg. 2000; 32(3): 411−9.

Vitti MJ, Thompson BW, Read RC, Gagne PJ, Barone GW, Barnes RW, et al. Carotid-subclavian bypass: a twenty two year expe-rience. J Vasc Surg 1994; 20(3): 411−7; discussion 417−8.

Bachman DM, Kim RH. Transluminal dilatation for subclavian steal syndrome. AJR Am J Roentgenol 1980; 135(3): 539−47.

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(3): 254−60.

Motarjeme A. Percutaneous transluminal angioplasty of supra-aortic vessels. J Endovasc Surg. 1996; 3: 171−81.

AbuRahma AF, Bates MC, Stone PA, Dyer B, Armistead L, Scott L, et al. Angioplasty and stenting versus carotid-subclavian by-pass for the treatment of isolated subclavian artery disease. J Endovasc Ther 2007; 14(5): 698−704.

de Vries JP, Jager LC, van den Berg JC, Overtoom TT, Ackerstaff RG, van de Pavoordt ED, et al. Durability of percutaneous trans-luminal angioplasty for obstructive lesions of proximal subcla-vian artery: Long-term results. J Vasc Surg 2005; 41(1): 19−23.

Sagic D, Miric M, Popovic Z, Bojic M. Endovascular procedures of the brachiocephalic vessels: 'snare' technique. 6th World Congress on Heart Failure – Mechanisms and Management. Geneva, Switzerland, May 17-20, 1998. J Heart Failure 1998; 5(N−1): 542.

Sagic D, Radak DJ, Peric M, Ilijevski N, Sajic Z, Petrovic BB, et al. Endovascular procedures in the treatment of obstructive le-sions of the brachiocephalic arteries. Folia Cardiol 2002; 59(3): 255−9. (Serbian)

Babic S, Sagic D, Radak D, Antonic Z, Otasevic P, Kovacevic V, et al. Initial and Long-term Results of Endovascular Therapy for Chronic Total Occlusion of the Subclavian Artery. Cardiovasc Intervent Radiol 2012; 35(2): 55−62.

Soga Y, Tomoi Y, Fujihara M, Okazaki S, Yamauchi Y, Shintani Y, et al. Perioperative and Long-term Outcomes of Endovascular Treatment for Subclavian Artery Disease From a Large Multi-center Registry. J Endovasc Ther 2015; 22(4): 626−33.

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 Ra-diol 2004; 27(6): 616−23.

Wang K, Wang Z, Yang B, Yuan C, Zhang W, Yuan B, et al. Long-term results of endovascular therapy for proximal subclavian arterial obstructive lesions. Chin Med J (Engl) 2010; 123(1): 45−50.

George JC, O'murchu B, Bashir R. Endovascular Management of Subclavian Artery Stenosis Using Ballon Expandable Covered Stents. J Cardiol Cases 2011; 3(3): 159−62.

Modarai B, Ali T, Dourado R, Reidy JF, Taylor PR, Burnand KG. Comparison of extra-anatomic bypass grafting with angioplasty for atherosclerotic disease of the supraaortic trunks. Br J Surg 2004; 91(11): 1453−7.

Farina C, Mingoli A, Schultz RD, Castrucci M, Feldhaus RJ, Rossi P, et al. Percutaneous transluminal angioplasty versus surgery for subclavian artery occlusive disease. Am J Surg 1989; 158(6): 511−4.

Linni K, Ugurluoglu A, Mader N, Hitzl W, Magometschnigg H, Hölzenbein TJ. Endovascular management versus surgery for proximal subclavian artery lesions. Ann Vasc Surg 2008; 22(6): 769−75.

Song L, Zhang J, Li J, Gu Y, Yu H, Chen B, et al. Endovascular stenting vs. extrathoracic surgical bypass for symptomatic sub-clavian steal syndrome. J Endovasc Ther 2012; 19(1): 44−51.

Supplementary files
Published
2018/08/17
Section
Original Paper