PTA of the subclavian and innominate arteries: long-term results

Abstract

Background: To investigate the long-term clinical and duplex sonographic results of percutaneous transluminal angioplasty (PTA) of the subclavian and innominate arteries, and the potential of a new double balloon technique to avoid cerebrovascular thromboembolism.

Patients and methods: Forty-three PTAs were performed on 38 subclavian, four innominate arteries and one subclavian-subclavian bypass in 37 patients. In three instances a protective double balloon technique was used. Indication for the intervention was: subclavian steal syndrome (n = 14 [38%]), upper extremity arterial insufficiency (n = 26 [70%]), peripheral thromboembolism (n = 8 [22%]) and PRIND/stroke (n = 3 [8%]). Analysis of long-term follow-up (median 15, range 2 to 100 months) was possible of 28 patients including duplex sonographic assessment in 23 patients. The cumulative patency rate was calculated by means of life-table analysis.

Results: Technical success was achieved in 36 endovascular procedures (84%). Minor peripheral catheter complications occurred in three interventions (7%), cerebrovascular thromboembolism in four (9%). No cerebrovascular complications were seen using the double balloon technique. On final check-up 4 patients (14%) suffered from subclavian steal syndrome, 3 (11%) from mild upper extremity arterial insufficiency and one (4%) from rest pain. Duplex sonography showed no stenosis in 12 of 23 patients (52%) and a stenosis of less than 50% in 8 (35%). The life-table analysis showed a secondary cumulative patency rate of 72% after 100 months with all restenoses occurring within 24 months.

Conclusions: PTA of the subclavian and innominate arteries appears to be a useful alternative to surgery with a low complication rate. The long-term patency rate of 72% is comparable to results of other series. In high risk situations cerebrovascular complications may be reduced using the new double balloon technique.