REAL-WORLD TREATMENT STRATEGIES AND EARLY OUTCOMES IN SUBCLAVIAN ARTERY OCCLUSIVE DISEASE: A SINGLE-CENTER EXPERIENCE
DOI:
https://doi.org/10.22551/Keywords:
SUBCLAVIAN ARTERY, OCCLUSIVE DISEASE, ENDOVASCULAR TREATMENT, HYBRID REVASCULARIZATION, STENTINGAbstract
The aim of this study was to evaluate treatment strategies and early outcomes in patients undergoing revascularization for symptomatic subclavian artery occlusive disease. Materials and methods: A retrospective single-center study included 18 consecutive patients treated between January 2021 and December 2024. Demographic, clinical, imaging, procedural, and follow-up data were retrospectively analyzed. Early outcomes were compared according to lesion morphology (stenotic versus occlusive/thrombotic) and clinical presentation. Results: The mean patient age was 64.1 ± 8.5 years, and 55.6% were male. Endovascular treatment was performed in 72.2% of patients, whereas hybrid procedures were required in 44.4%. Overall technical success was achieved in 77.8% of cases. Primary patency and symptom improvement were documented in 66.7% of patients. Stent implantation was significantly more frequent in stenotic than in occlusive/thrombotic lesions (100.0% vs. 10.0%, p = 0.001). Symptom improvement was also more common in stenotic lesions (100.0% vs. 50.0%, p = 0.015). Conclusions: Endovascular treatment was the predominant revascularization strategy and provided favorable early outcomes in symptomatic subclavian artery occlusive disease. Lesion morphology significantly influenced treatment selection, technical success, and clinical improvement, supporting an individualized approach based on anatomical and clinical characteristics.
References
1. Ben Ahmed S, Settembre N, Touma J, et al. AURC (Association Universitaire pour la Recherche en Chirurgie) collaborators. Outcomes in the treatment of aberrant subclavian arteries using the hybrid approach. Interact Cardiovasc Thorac Surg 2022; 35(5): ivac230 / doi: 10.1093/ icvts/ivac230.
2. Wei L, Gao X, Tong Z, et al Outcomes of covered stents versus bare-metal stents for subclavian artery occlusive disease. Front Cardiovasc Med 2023; 10: 1194043 / doi: 10.33 89/fcvm.2023. 1194043.
3. Zhang JL, Tong W, Lv JF, Chi LX. Endovascular treatment and morphology typing of chronic ostial occlusion of the subclavian artery. Exp Ther Med 2017; 13(5): 2022-2028 / doi: 10.3892/ etm.2017.4203.
4. Zhang J, Wang L, Chen Y. Color Doppler Ultrasonography for the Evaluation of Subclavian Artery Stenosis. Front Neurol 2022; 13: 804039 / doi: 10.3389/ fneur.2022.804039.
5. Ni H, Zhong Z, Zhu J, et al. Single-Stage Endovascular Treatment of Severe Cranial Artery Stenosis Coexisted with Ipsilateral Distal Tandem Intracranial Aneurysm. Front Neurol. 2022; 13: 865540 / doi: 10.3389/fneur.2022.865540.
6. Galyfos GC, Kakisis I, Maltezos C, Geroulakos G. Open versus endovascular treatment of sub-clavian artery atherosclerotic disease. J Vasc Surg 2019; 69(1): 269-279.e7 / doi: 10.1016/j.jvs. 2018.07.028.
7. Almeida BL, Kambara AM, Rossi FH, et al Left subclavian artery stenting: an option for the treatment of the coronary-subclavian steal syndrome. Rev Bras Cir Cardiovasc 2014; 29(2): 236-40 / doi: 10.5935/1678-9741.20140031.
8. McCluskey M, Baber, P, Rind, S, Xu, D. Variant of subclavian steal syndrome: unusual anatom-ical relationship between left subclavian artery and left vertebral artery. BMJ Case Rep 2023; 16(4): e252966 / doi: 10.1136/bcr-2022-252966.
9. Alhowary AA, Gharaibeh S, Aleshawi A. Successful Management of Incidentally-Detected Subclavian Stenosis During Anesthetic Preparation for Spinal Surgery: A Case Report. Int Med Case Rep J 2025; 18: 699-704 / doi: 10.2147/IMCRJ.S515664.
10. Leach DF 3rd, Radwanski DM, Kaur P, Das DD, Kondapalli M. Recurrent Subclavian Steal Syndrome: A Novel Case of Vasculopathy. Cureus 2023; 15(1): e33310. / doi: 10.7759/cureus. 33310.
11. Meller L, Wilson, K, Huang, B, Kalavacherla, S, Vitale, K. Underlying Subclavian Artery Oc-clusion Initially Misdiagnosed in Weightlifter Using Anabolic Steroids: A Case Report and Review of Literature. Cureus. 2023; 15(4): e37763. / doi: 10.7759/cureus.37763.
12. Montano A, Halicek M, Collier V, Reese B. Critical Left Subclavian Artery Stenosis with Ret-rograde Vertebral Flow: A Case Report and Literature Review. Cureus 2023; 15(12): e51027 / doi: 10.7759/cureus.51027.
13. Ugolini E, La Civita G, Ferraresi M, et al Hemodynamic Impact of the Aberrant Subclavian Artery: A CFD Investigation. J Pers Med 2025; 15(12): 603 / doi: 10.3390/jpm15120603.
14. Orozco-Sevilla V, Coselli JS. Management of the left subclavian artery during aortic arch re-placement using a frozen elephant trunk approach: a review. Cardiovasc Diagn Ther. 2023; 13(4): 736-742 / doi: 10.21037/cdt-22-248.
15. Van Nut L, Vinh PX, Vuong NL. Endovascular Treatment for Subclavian Artery Stenosis and Occlusion: A Single-Center Retrospective Study. Cureus 2023; 15(9): e44699 / doi: 10.7759/ cureus.44699.
16. Okabe, H, Doi, H, Kataoka, M. Endovascular Treatment of Subclavian Artery Occlusion by Surgical Exposure of the Proximal Brachial Artery at the Side of an Arteriovenous Fistula. Intern Med. 2023; 62(19): 2855-2858 / doi: 10.2169/internalmedicine.1120-22.
17. Mashayekhi, K.A, Pyxaras, S.A, Werner, G.S, et al. C. Contemporary issues of percutaneous coronary intervention in heavily calcified chronic total occlusions: an expert review from the European CTO Club. EuroIntervention. 2023; 19(2): e113-e122 / doi: 10.4244/EIJ-D-22-01096.
18. Likaj E, Kuci S, Ibrahimi A, et al. Hybrid and Total Endovascular Solutions for Aortic Arch Disease: Contemporary Surgical Strategies. J Clin Med 2026; 15(5): 1946 / doi: 10.3390/jcm 15051946.
19. Dake MD, Brinkman WT, Han SM, et al. Outcomes of endovascular repair of aortic aneurysms with the GORE thoracic branch endoprosthesis for left subclavian artery preservation. J Vasc Surg. 2022; 76(5): 1141-1149.e3. / doi: 10.1016/j.jvs.2022.05.014.
20. Ozcinar E, Dikmen N, Baran C, Buyukcakir O, Kandemir M, Yazicioglu L. Comparative Retro-spective Cohort Study of Carotid-Subclavian Bypass versus In Situ Fenestration for Left Sub-clavian Artery Revascularization during Zone 2 Thoracic Endovascular Aortic Repair: A Single-Center Experience. J Clin Med 2024; 13(17): 5043 / doi: 10.3390/jcm 13175043.
21. Onishi H, Naganuma, T, Hozawa, K, et al. Periprocedural and Long-Term Outcomes of Stent Implantation for De Novo Subclavian Artery Disease. Vasc Endovascular Surg 2019; 53(4): 284-291 / doi: 10.1177/1538574418824444.
22. Higashimori A, Morioka N, Shiotani S, Fujihara M, Fukuda K, Yokoi Y. Long-term results of primary stenting for subclavian artery disease. Catheter Cardiovasc Interv 2013; 82(5): 696-700 / doi: 10.1002/ccd.24916.
23. Endo M, Yata S, Takasugi S, et al. Latest Trend of Endovascular Treatment for Lower Extremity Artery Disease and Recommendations from Interventional Radiologist: To Continue Engaging in This Field Moving Forward. Interv Radiol (Higashimatsuyama) 2025; 10: e20240052 / doi: 10.22575/interventionalradiology.2024-0052.
24. Troisi N, Saratzis A, Katsogridakis E, et al. G. EMO-POP Registry Collaborative Group. Different endovascular modalities of treatment for isolated atherosclerotic popliteal artery lesions (EMO-POP) registry. J Vasc Surg 2023; 77(1): 231-240.e4 / doi: 10.1016/j.jvs. 2022.07.170.
25. Marinescu D, Barbu LA, Țenea Cojan TS, et al. Vascular Changes and Surgical Risk in Cervical vs. Endometrial Cancer After Radiotherapy: A Retrospective Cohort Study. Life 2026; 16: 71 / doi: 10.3390/life16010071.
26. Marinescu D, Barbu LA, Cojan, TS, et al. Concomitant Venous Disease in Patients with Advanced Peripheral Arterial Disease: A Patient- and Limb-Level Analysis. Life 2026; 16: 312 / doi: 10.3390 /life16020312.
27. Liu Y, Wu, Z, Wei, S, He, W, et al. Predictors of successful recanalization following endovascular intervention in non-acute basilar artery occlusion. Front Neurol 2025; 16: 1496852. / doi: 10.3389/fneur.2025.1496852.
28. Kim YH, Bae JI, Jeon YS, et al. Korean Guidelines for Interventional Recanalization of Lower Extremity Arteries. Korean J Radiol 2015; 16(4): 696-722 / doi: 10.3348/ kjr. 2015. 16.4.696.
29. Tang D, Liu C. Analysis of risk factors for in-stent restenosis in patients with coronary heart disease after PCI. Medicine (Baltimore) 2025; 104(48): e46088 / doi: 10.1097/MD.0000000000 046088.
30. Alraies MC, Darmoch F, Tummala R, Waksman R. Diagnosis and management challenges of in-stent restenosis in coronary arteries. World J Cardiol 2017; 9(8): 640-651 / doi:10.43 30/wjc.v 9.i8.640.
31. Zhang, B, Niu, G, Yan, Z, Zou, Y, Tong, X, Yang, M. Midterm outcomes of endovascular treatment with bare metal stents for Leriche syndrome patients. Interact Cardiovasc Thorac Surg. 2021; 32(1): 83-88. / doi: 10.1093/icvts/ivaa223.
32. Zeng C, Wu Z, Lei J, et al. Covered Stents vs Bare Metal Stents for Aortoiliac Arterial Diseases: A Systematic Review and Meta-Analysis. J Endovasc Ther 2025; 32(5): 1317-1325 / doi: 10.1177/15266028231212761.
33. Niu G, Yan Z, Zhang B, Yang M. Endovascular Treatment of Chronic Total Occlusion in the Subclavian Artery: A Review of 23 Cases. Front Neurol 2020; 11: 264 / doi: 10.3389/fneur. 2020.00264.
34. Krishnappa S, Rachaiah JM, Hegde SS, et al. Percutaneous Antegrade and Retrograde Endovas-cular approach to Symptomatic High-Grade Subclavian Artery Stenosis: Technique and Follow-Up. Heart Views 2019; 20(3): 87-92 / doi: 10.4103/HEART VIEWS. HEARTVIEWS_31_18.
35. Huffman J, Nichols WK, Bath J. Current Hybrid Interventions in Vascular Surgery: Merging Past and Present. Mo Med 2021; 118(4): 381-386.
36. Gao Z, Yue Y, Zhang Y, et al. Comparison of Clinical Outcomes of Endovascular Therapy and Hybrid Surgery in the Treatment of Trans-Atlantic Inter-Society Consensus II D Aortoiliac Oc-clusive Disease. Int J Gen Med 2023; 16: 2149-2156 / doi: 10.2147/ IJGM.S408609.
37. Putnam JP, Thompson MA, Frankel WC, et al. Open, hybrid, and endovascular repair of re-coarctation, aneurysm, and pseudoaneurysm after aortic coarctation repair. JTCVS Tech 2025; 35: 102121 / doi: 10.1016/j.xjtc.2025.09.033.
38. Qiu H, Kang Z, Sun D, Mei B, Zhang J. Case report: Retrograde endovascular recanalization of vertebral artery occlusion with non-tapered stump via the deep cervical collateral. Front Neurol 2023; 14: 1246151 / doi: 10.3389/fneur.2023.1246151.
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