Application of subclavian-carotid transposition to patients with proximal subclavian artery occlusion unable to be intervened_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GU Yuanrui , SUN Yangxue , TIAN Chen , LUO Mingyao , FANG Kun , SHU Chang ,  OUYANG Chenxi

Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding author：

OUYANG Chenxi, Email: ouyangchx@nccd.org.cn

Keywords：

Subclavian-carotid transposition; subclavian artery occlusion; steal syndrome; interventional therapy

DOI：

10.7507/1007-4848.202001012

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the efficacy of subclavian-carotid transposition (SCT) in treating patients with proximal subclavian artery occlusive diseases who were unable to be intervened, such as failure of intervention, congenital malformation and unwillingness to intervention.Methods A retrospective review of 19 patients with proximal subclavian artery occlusion who underwent SCT from May 2016 to December 2018 was done. There were 14 males and 5 females with an average age of 54.05±17.34 years. The advantages and disadvantages of SCT in the treatment of proximal subclavian artery occlusion were analyzed.Results All patients achieved immediate remission of symptoms after surgery. The stenosis degree of the proximal subclavian artery decreased from 100.0%±0.0% to 12.7%±10.1% after surgery. The average blood pressure difference between the unaffected side and the affected side decreased from 11.95±10.60 mm Hg to 0.89±5.75 mm Hg (P<0.01). Peripheral nerve injury occurred in 7 (36.8%) patients. The in-patient cost of subclavian artery occlusion patients who received subclavian artery interventional therapy in our hospital during the corresponding period was 3 392.12 yuan higher than that of the SCT group in average (if eliminating the patients whose cost was far from the average value, the cost of interventional therapy was 4 812.01 yuan higher than that of the SCT group in average). During 1-3 years' follow-up, 6 patients with neurological complication relieved. One- and three-year patency rates were 100.0%. No perioperative stroke, death or re-operation happened.Conclusion SCT is an ideal process for the patients with subclavian artery occlusion who cannot accept subclavian artery interventional therapy.

Citation： GU Yuanrui, SUN Yangxue, TIAN Chen, LUO Mingyao, FANG Kun, SHU Chang, OUYANG Chenxi. Application of subclavian-carotid transposition to patients with proximal subclavian artery occlusion unable to be intervened. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(9): 1005-1009. doi: 10.7507/1007-4848.202001012 Copy

1.	Fields WS, Lemak NA. Joint study of extracranial arterial occlusion. Ⅶ. Subclavian steal—a review of 168 cases. JAMA, 1972, 222(9): 1139-1143.
2.	Bryan AJ, Hicks E, Lewis MH. Unilateral digital ischaemia secondary to embolisation from subclavian atheroma. Ann R Coll Surg Engl, 1989, 71(2): 140-142.
3.	Sueoka BL. Percutaneous transluminal stent placement to treat subclavian steal syndrome. J Vasc Interv Radiol, 1996, 7(3): 351-356.
4.	Olsen CO, Dunton RF, Maggs PR, <italic>et al</italic>. Review of coronary-subclavian steal following internal mammary artery-coronary artery bypass surgery. Ann Thorac Surg, 1988, 46(6): 675-678.
5.	AbuRahma AF, Robinson PA, Jennings TG. Carotid-subclavian bypass grafting with polytetrafluoroethylene grafts for symptomatic subclavian artery stenosis or occlusion: a 20-year experience. J Vasc Surg, 2000, 32(3): 411-418.
6.	Ogawa A. Surgical reconstruction of the proximal vertebral artery: vertebral to subclavian transposition. No Shinkei Geka, 1991, 19(1): 7-13.
7.	Wylie EJ, Effeney DJ. Surgery of the aortic arch branches and vertebral arteries. Surg Clin North Am, 1979, 59(4): 669-680.
8.	AbuRahma AF, Bates MC, Stone PA, <italic>et al</italic>. Angioplasty and stenting versus carotid-subclavian bypass for the treatment of isolated subclavian artery disease. J Endovasc Ther, 2007, 14(5): 698-704.
9.	De Bakey ME, Morris GC Jr, Jordan GL Jr, <italic>et al</italic>. Segmental thrombo-obliterative disease of branches of aortic arch; successful surgical treatment. J Am Med Assoc, 1958, 166(9): 998-1003.
10.	Cinà CS, Safar HA, Laganà A, <italic>et al</italic>. Subclavian carotid transposition and bypass grafting: consecutive cohort study and systematic review. J Vasc Surg, 2002, 35(3): 422-429.
11.	Schardey HM, Meyer G, Rau HG, <italic>et al</italic>. Subclavian carotid transposition: an analysis of a clinical series and a review of the literature. Eur J Vasc Endovasc Surg, 1996, 12(4): 431-436.
12.	Parrott JC. The subclavian steal syndrome. Arch Surg, 1964, 88: 661-665.
13.	Bachman DM, Kim RM. Transluminal dilatation for subclavian steal syndrome. AJR Am J Roentgenol, 1980, 135(5): 995-996.
14.	Joseph S, Mandalam KR, Rao VR, <italic>et al</italic>. Percutaneous transluminal angioplasty of the subclavian artery in nonspecific aortoarteritis: results of long-term follow-up. J Vasc Interv Radiol, 1994, 5(4): 573-580.
15.	Mathias KD, Lüth I, Haarmann P. Percutaneous transluminal angioplasty of proximal subclavian artery occlusions. Cardiovasc Intervent Radiol, 1993, 16(4): 214-218.
16.	Millaire A, Trinca M, Marache P, <italic>et al</italic>. Subclavian angioplasty: immediate and late results in 50 patients. Cathet Cardiovasc Diagn, 1993, 29(1): 8-17.
17.	Tyagi S, Verma PK, Gambhir DS, <italic>et al</italic>. Early and long-term results of subclavian angioplasty in aortoarteritis (Takayasu disease): comparison with atherosclerosis. Cardiovasc Intervent Radiol, 1998, 21(3): 219-224.
18.	Bogey WM, Demasi RJ, Tripp MD, <italic>et al</italic>. Percutaneous transluminal angioplasty for subclavian artery stenosis. Am Surg, 1994, 60(2): 103-106.
19.	Ahmed AT, Mohammed K, Chehab M, <italic>et al</italic>. Comparing percutaneous transluminal angioplasty and stent placement for treatment of subclavian arterial occlusive disease: a systematic review and meta-analysis. Cardiovasc Intervent Radiol, 2016, 39(5): 652-667.
20.	De Roeck F, Tijskens M, Segers VFM. Coronary-subclavian steal syndrome, an easily overlooked entity in interventional cardiology. Catheter Cardiovasc Interv, 2019, [Epub ahead of print].
21.	Hillis LD, Smith PK, Anderson JL, <italic>et al</italic>. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg, 2012, 143(1): 4-34.
22.	European Stroke Organisation, Tendera M, Aboyans V, <italic>et al</italic>. ESC guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J, 2011, 32(22): 2851-2906.

1. Fields WS, Lemak NA. Joint study of extracranial arterial occlusion. Ⅶ. Subclavian steal—a review of 168 cases. JAMA, 1972, 222(9): 1139-1143.
2. Bryan AJ, Hicks E, Lewis MH. Unilateral digital ischaemia secondary to embolisation from subclavian atheroma. Ann R Coll Surg Engl, 1989, 71(2): 140-142.
3. Sueoka BL. Percutaneous transluminal stent placement to treat subclavian steal syndrome. J Vasc Interv Radiol, 1996, 7(3): 351-356.
4. Olsen CO, Dunton RF, Maggs PR, <italic>et al</italic>. Review of coronary-subclavian steal following internal mammary artery-coronary artery bypass surgery. Ann Thorac Surg, 1988, 46(6): 675-678.
5. AbuRahma AF, Robinson PA, Jennings TG. Carotid-subclavian bypass grafting with polytetrafluoroethylene grafts for symptomatic subclavian artery stenosis or occlusion: a 20-year experience. J Vasc Surg, 2000, 32(3): 411-418.
6. Ogawa A. Surgical reconstruction of the proximal vertebral artery: vertebral to subclavian transposition. No Shinkei Geka, 1991, 19(1): 7-13.
7. Wylie EJ, Effeney DJ. Surgery of the aortic arch branches and vertebral arteries. Surg Clin North Am, 1979, 59(4): 669-680.
8. AbuRahma AF, Bates MC, Stone PA, <italic>et al</italic>. Angioplasty and stenting versus carotid-subclavian bypass for the treatment of isolated subclavian artery disease. J Endovasc Ther, 2007, 14(5): 698-704.
9. De Bakey ME, Morris GC Jr, Jordan GL Jr, <italic>et al</italic>. Segmental thrombo-obliterative disease of branches of aortic arch; successful surgical treatment. J Am Med Assoc, 1958, 166(9): 998-1003.
10. Cinà CS, Safar HA, Laganà A, <italic>et al</italic>. Subclavian carotid transposition and bypass grafting: consecutive cohort study and systematic review. J Vasc Surg, 2002, 35(3): 422-429.
11. Schardey HM, Meyer G, Rau HG, <italic>et al</italic>. Subclavian carotid transposition: an analysis of a clinical series and a review of the literature. Eur J Vasc Endovasc Surg, 1996, 12(4): 431-436.
12. Parrott JC. The subclavian steal syndrome. Arch Surg, 1964, 88: 661-665.
13. Bachman DM, Kim RM. Transluminal dilatation for subclavian steal syndrome. AJR Am J Roentgenol, 1980, 135(5): 995-996.
14. Joseph S, Mandalam KR, Rao VR, <italic>et al</italic>. Percutaneous transluminal angioplasty of the subclavian artery in nonspecific aortoarteritis: results of long-term follow-up. J Vasc Interv Radiol, 1994, 5(4): 573-580.
15. Mathias KD, Lüth I, Haarmann P. Percutaneous transluminal angioplasty of proximal subclavian artery occlusions. Cardiovasc Intervent Radiol, 1993, 16(4): 214-218.
16. Millaire A, Trinca M, Marache P, <italic>et al</italic>. Subclavian angioplasty: immediate and late results in 50 patients. Cathet Cardiovasc Diagn, 1993, 29(1): 8-17.
17. Tyagi S, Verma PK, Gambhir DS, <italic>et al</italic>. Early and long-term results of subclavian angioplasty in aortoarteritis (Takayasu disease): comparison with atherosclerosis. Cardiovasc Intervent Radiol, 1998, 21(3): 219-224.
18. Bogey WM, Demasi RJ, Tripp MD, <italic>et al</italic>. Percutaneous transluminal angioplasty for subclavian artery stenosis. Am Surg, 1994, 60(2): 103-106.
19. Ahmed AT, Mohammed K, Chehab M, <italic>et al</italic>. Comparing percutaneous transluminal angioplasty and stent placement for treatment of subclavian arterial occlusive disease: a systematic review and meta-analysis. Cardiovasc Intervent Radiol, 2016, 39(5): 652-667.
20. De Roeck F, Tijskens M, Segers VFM. Coronary-subclavian steal syndrome, an easily overlooked entity in interventional cardiology. Catheter Cardiovasc Interv, 2019, [Epub ahead of print].
21. Hillis LD, Smith PK, Anderson JL, <italic>et al</italic>. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg, 2012, 143(1): 4-34.
22. European Stroke Organisation, Tendera M, Aboyans V, <italic>et al</italic>. ESC guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J, 2011, 32(22): 2851-2906.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of subclavian-carotid transposition to patients with proximal subclavian artery occlusion unable to be intervened

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content