Subclavian steal syndrome – surgical or endovascular treatment

Vladimir Z Cvetić; Momčilo Čolić; Oliver Radmili; Igor Banzić; igor Končar; Borivoje Lukić; Lazar Davidović

doi:10.2298/VSP160215215C

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

DOI: https://doi.org/10.2298/VSP160215215C

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.

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