Issue: Vojnosanit Pregl 2017; Vol. 74 (No. 12)

Subclavian steal syndrome – surgical or endovascular treatment

Authors:
Vladimir Cvetić, Momčilo Čolić, Oliver Radmili, Igor Banzić, Igor Končar, Borivoje Lukić, Lazar Davidović

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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.