Outcomes of covered stents versus bare-metal stents for subclavian artery occlusive disease

Clinical study of 57 cases of endovascular treatment for total subclavian artery occlusion

ObjectiveTo investigate the safety and efficacy of endovascular treatment for totally occlusive lesions of the subclavian artery (SCA).MethodsA retrospective study was performed on 57 patients treated with angioplasty and stenting, including 42 males and 15 females, with an average age of 61.8 years (range: 49 to 81 years). Efficacy, safety, and complications were evaluated.ResultsProcedural success was achieved for 47/57 patients and symptoms were relieved. Rat-tail occlusion is the most common type, and all cases were successfully recanalized. Plain type occlusion is less common with a recanalization rate of 55.6%. Hilly and plain occlusions are the main types of stent implantation failure. Through univariate analysis and trend matching analysis, the type of SCA occlusion and surgical approach had statistical significance on the success rate of surgery. The mean follow-up time was 34.6 ± 16.2 months. The cumulative stent patency rates at 1, 3, and 5 years were 95.5%, 86.4%, and 77.3% in the calcified plaque group and 92.0%, 76.0%, and 68.0% in the non-calcified plaque group, respectively. The 3-year and 5-year patency rates in the calcified plaque group were higher than those in the non-calcified plaque group (p < .05).ConclusionDifferent occlusion types and surgical approaches can affect the surgical success rate. The combined femoral and brachial approach can improve the rate of recanalization of SCA occlusions. The patency rates at 3 and 5 years in the calcified plaque group were higher than those in the non-calcified plaque group.

Uncommon Presentation of Recurrent Lung Adenocarcinoma: A Finger Ulcer Induced by Subclavian Artery Invasion Successfully Healed With Viabahn VBX Treatment

Recurrence of a lung tumor invading the subclavian artery, causing stenosis and leading to finger ulcers as the initial symptom, is rare. We employed endovascular techniques, inserting a Viabahn® VBX covered stent (W. L. Gore & Associates, Flagstaff, Arizona) to aid in ulcer healing and improve the patient's quality of life. The patient, a 73-year-old male, had a history of lung adenocarcinoma resection two years prior but had not undergone follow-up examinations or cancer-specific treatments. Clinical examination revealed an invasion of the right subclavian artery by the recurrent tumor, resulting in severe stenosis and ischemic symptoms in the right upper limb. Given the patient's advanced cancer stage and the decline of further tumor-specific treatments, an endovascular intervention using a Viabahn VBX covered stent was performed to improve blood flow and promote ulcer healing. The stent demonstrated exceptional stability and patency during the six-month follow-up, greatly improving the patient's quality of life. This case highlights the importance of recognizing atypical symptoms as potential indicators of tumor recurrence or progression and demonstrates the promising role of covered stents in managing vascular complications in selected patients with advanced-stage malignancies.

Hybrid Repair of Left Subclavian Artery Pseudoaneurysm With Vertebral Artery Revascularisation: A Solution for a Complex Case

Introduction

Pseudoaneurysms of the subclavian artery are a rare complication. Surgical treatment is necessary to prevent potentially lethal complications. This needs adequate planning in cases that require vertebral artery revascularisation.

Report

A 56 year old man with multiple systemic comorbidities underwent endovascular treatment using a balloon expandable bare metal stent for symptomatic subclavian Steal syndrome. During follow up, computed tomography angiography (CTA) revealed a pseudoaneurysm in the proximal segment of the left subclavian artery. The patient had criteria warranting left vertebral artery revascularisation. The patient underwent scheduled hybrid surgical treatment involving transposition of the vertebral artery to the common carotid artery, endarterectomy of the internal carotid artery, and endovascular therapy for pseudoaneurysm exclusion; all were performed on the left side. The post-operative period was without incident. After 12 months the patient remains asymptomatic, with adequate exclusion of the pseudoaneurysm, and patency of the procedures.

Discussion

Hybrid surgery could offer a secure, feasible, and less invasive option for treating subclavian artery pseudoaneurysms that require vertebral artery revascularisation.