Open Access Original

Article DOI: 10.7759/cureus.44699

Endovascular Treatment for Subclavian Artery

Stenosis and Occlusion: A Single-Center
Review began 08/28/2023
Retrospective Study
Review ended 09/03/2023
Published 09/05/2023 Lam Van Nut 1 , Pham Xuan Vinh 2 , Nguyen Lam Vuong 3

© Copyright 2023
Van Nut et al. This is an open access article 1. Department of Vascular Surgery, Cho Ray Hospital, Ho Chi Minh City, VNM 2. Thoracic and Vascular Department,
distributed under the terms of the Creative Thu Duc City Hospital, Ho Chi Minh City, VNM 3. Department of Medical Statistics and Informatics, Faculty of Public
Commons Attribution License CC-BY 4.0., Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
which permits unrestricted use, distribution,
and reproduction in any medium, provided
Corresponding author: Nguyen Lam Vuong, [email protected]
the original author and source are credited.

Abstract
Background: Subclavian artery stenosis and occlusion are common arterial diseases in the upper extremities,
with atherosclerosis being the main cause. Endovascular treatment has emerged as a promising alternative
to open surgical repair, but data are limited. This study aimed to evaluate the safety and effectiveness of
endovascular procedures in the treatment of subclavian artery lesions at a tertiary vascular center in
Vietnam.

Methods: A retrospective analysis was conducted on patients who underwent endovascular treatment for
symptomatic subclavian artery stenosis or occlusion between October 2013 and April 2022. Clinical
characteristics, procedural details, short- and long-term outcomes, and patency rates were assessed.

Results: Twenty-five patients were included in the study, with a mean age of 56.8 years. The majority of
patients had risk factors for atherosclerosis, and all presented with symptoms related to subclavian artery
disease. The endovascular procedures were successful in 96% of cases, with a low complication rate of 8%.
During a median follow-up of 43 months, the overall patency rate was 92% at three years.

Conclusion: Endovascular treatment of subclavian artery stenosis and occlusion is a safe and effective
option, with excellent long-term patency rates. These findings support the use of percutaneous
revascularization as the first-line therapy, particularly in experienced centers. Further studies with larger
sample sizes and longer follow-up periods are needed to confirm these results.

Categories: Cardiac/Thoracic/Vascular Surgery

Keywords: patency, occlusion, stenosis, arteriosclerosis, endovascular treatment, subclavian artery

Introduction
The subclavian artery is a frequently affected site for occlusive and stenotic arterial conditions in the upper
extremities. The steno-occlusive disease of the subclavian artery is found in approximately 2-4% of the
general population [1,2] and this prevalence rises to 11-18% in individuals with atherosclerotic diseases,
such as peripheral artery or coronary artery disease [2,3].

The primary cause of subclavian artery stenosis or occlusion is atherosclerosis. However, less common
etiologies include Takayasu's arteritis, radiation-induced vascular disease, and impedance caused by nearby
tumors [2,4-6]. While many patients with subclavian artery stenosis or occlusion are asymptomatic, some
may experience severe symptoms, including subclavian steal syndrome, upper extremity ischemia, or
myocardial ischemia in those with a coronary arterial bypass grafting utilizing an internal mammary artery
[7-9].

Revascularization becomes essential for patients experiencing symptoms or complications to prevent upper
extremity necrosis, stroke, and mortality. Traditionally, open surgical repair has been the main approach for
addressing this issue. However, this major surgery involves challenging techniques and carries a high rate of
complications [10,11]. Fortunately, recent advancements in materials and technical expertise have ushered
in a new era, with endovascular intervention replacing surgery as the first-line treatment option [12,13].
Several studies have highlighted the feasibility and favorable outcomes of endovascular treatment for
subclavian artery stenosis or occlusion [14-20]. However, these studies have been limited by their
retrospective nature and small sample sizes, with no available randomized trials.

In Vietnam, endovascular intervention for subclavian artery stenosis or occlusion has been employed since
2013 in select tertiary vascular centers. While results are anticipated to be as promising as those reported in
other countries worldwide, no specific data from Vietnam are currently available. With the present study,
our objective is to evaluate the short- and long-term outcomes of endovascular procedures performed at our

How to cite this article

Van Nut L, Vinh P, Vuong N (September 05, 2023) Endovascular Treatment for Subclavian Artery Stenosis and Occlusion: A Single-Center
Retrospective Study. Cureus 15(9): e44699. DOI 10.7759/cureus.44699
 institution over a span of 10 years in treating subclavian artery lesions.

Materials And Methods

Study design and population
This study is a retrospective analysis of patients who underwent endovascular treatment for subclavian
artery stenosis or occlusion at the Department of Vascular Surgery, Cho Ray Hospital, Ho Chi Minh City,
Vietnam, between October 2013 and April 2022. Cho Ray Hospital is a renowned tertiary care center, serving
as a high-volume facility for vascular treatment in Southern Vietnam, catering to a population of nearly 50
million people. Ethical approval for this study was obtained from the Ethics Committee of the University of
Medicine and Pharmacy at Ho Chi Minh City (Approval No. 540/HĐĐĐ-ĐHYD, dated 2 June 2022).

We included all patients diagnosed with symptomatic stenosis or occlusion of the subclavian artery,
suspected to be caused by atherosclerosis, and who subsequently underwent endovascular treatment.
Patients with stenosis or occlusion due to other etiologies, such as trauma, extrinsic obstruction by tumors,
or thrombosis leading to acute disease, were excluded from the study. Prior to performing the intervention,
written informed consent was obtained from all patients and their relatives.

Revascularization for subclavian artery lesions in our institution followed the following standard criteria: (i)
stenosis of 70% or above or complete occlusion of the artery's inner diameter, and (ii) corresponding
symptoms with subclavian artery stenosis or occlusion, such as the presence of steal syndrome with
vertebrobasilar insufficiency symptoms (e.g., vertigo, diplopia, or optometry) or chronic upper limb ischemia
(e.g., arm claudication, rest pain, numbness, or ulcers). The indication for revascularization was determined
on a case-by-case basis, considering individual patient factors, including symptomatology, concomitant
medical conditions, surgical risk, available vascular access routes, life expectancy, and patient preferences.

Data collection
Data for this study was retrieved from medical records, radiology reports, and operative notes. Demographic
information, such as age, sex, and comorbidities, was collected. Preoperative clinical symptoms and imaging
findings were recorded. Intra- and postoperative parameters, as well as any complications, were also
documented.

The endovascular intervention was carried out under either local or general anesthesia. During the
procedure, systemic heparin was administered to maintain an activated clotting time of approximately 250
seconds. We preferred a retrograde approach to cross the subclavian lesion, utilizing an ipsilateral brachial
approach. If the retrograde access was unsuccessful, an antegrade approach with femoral access was utilized
as an alternative. Following the recanalization and balloon angioplasty of the subclavian disease segment,
the procedure was completed by deploying a balloon-expandable stent.

Early results of the intervention were evaluated by intraoperative angiography after stenting, and
brachiocephalic vessels duplex ultrasonography was conducted before patients were discharged from the
hospital. Upon discharge, all patients were prescribed oral dual antiplatelet therapy, comprising
acetylsalicylic acid (ASA) 75 mg and clopidogrel 75 mg daily for three months, followed by a single
antiplatelet agent for lifelong therapy. Patients underwent follow-up appointments at 1, 3, 6, and 12 months
after discharge, and subsequently on an annual basis at the outpatient department. During each visit,
clinical examination and duplex ultrasound were performed. Computed tomographic angiography (CTA) was
carried out if there were suspected cases of subclavian artery restenosis or occlusion. Reintervention was
indicated in cases of restenosis of the subclavian artery of more than 70%, the presence of steal syndrome
with vertebrobasilar insufficiency symptoms, and/or chronic upper limb ischemia.

Outcome measurement
Short-term outcomes were assessed based on technical success, postoperative complications, and 30-day
mortality. Technical success was defined as the achievement of a patent subclavian artery without
significant residual stenosis (less than 30% of the inner diameter) as determined by intraoperative
angiography after stenting, and duplex ultrasound before the patient's discharge. Postoperative
complications included any intraoperative accidents or occurrences of organ involvement that necessitated
postoperative medical or interventional intervention or prolonged the length of hospital stay. The 30-day
mortality category included all deaths from any cause within 30 days following the intervention.

Long-term outcomes encompassed the primary patency of the subclavian artery, occurrences of cardiac and
neurologic events, as well as all-cause mortality during the follow-up period. The identification of restenosis
was based on the recurrence of vessel lumen narrowing equal to or greater than 70%. Cardiac events were
recorded if there were any incidents involving the heart, such as ventricular fibrillation, complete heart
block, myocardial infarction, cardiac arrest, or cardiac death. Neurologic events included any incidents
involving the brain, such as transient ischemic attack, ischemic stroke, intracranial bleeding, coma, or brain
death. Any cardiac and neurologic events, as well as all-cause deaths, were documented based on medical

2023 Van Nut et al. Cureus 15(9): e44699. DOI 10.7759/cureus.44699 2 of 10

 records in the event of hospital admission or through the death certificate in case of mortality.

Statistical analysis
The statistical analysis included the summary of baseline characteristics and patient outcomes. Continuous
variables with a normal distribution were presented as mean ± standard deviation, while those with a skewed
distribution were summarized as median and interquartile range (IQR). Categorical variables were expressed
as frequencies and percentages. For long-term outcomes, Kaplan-Meier estimates were utilized, and the
results were depicted using Kaplan-Meier curves. The statistical analysis was performed using the R
statistical software version 4.1.3 (R Foundation for Statistical Computing, Vienna, Austria).

Results
During the study period from October 2013 to April 2022, a total of 25 patients with symptomatic subclavian
artery stenosis or occlusion underwent endovascular treatment at our hospital. The characteristics of the
patients are presented in Table 1. Male patients were predominant, accounting for 64% (16 out of 25
patients). The age of the patients ranged from 30 to 78 years, with a mean age of 56.8 years. The majority of
patients had several risk factors for atherosclerosis, including hypertension (72%), dyslipidemia (68%), and
smoking (64%). Additionally, 44% of patients had concomitant peripheral arterial disease in the lower
extremities. Furthermore, 28% had concomitant carotid disease, and 4% had concomitant coronary arterial
disease. All patients experienced symptoms related to subclavian stenosis or occlusion, with arm
claudication being the most prevalent symptom (100%), followed by numbness (84%) and pulse loss (68%).
Less common symptoms included cold skin (36%), ulcers (24%), vertigo (24%), pale skin (8%), and weakness
(8%).

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 All patients (N=25)

Sex

Male 16 (64.0)

Female 9 (36.0)

Age (years) 56.8 ± 14.2 (30; 78)

Comorbidities

Hypertension 18 (72.0)

Dyslipidemia 17 (68.0)

Smoking 16 (64.0)

Lower limb PAD 11 (44.0)

Carotid stenosis 7 (28.0)

Diabetes 4 (16.0)

CAD 1 (4.0)

Previous stroke 1 (4.0)

Symptoms

Arm claudication 25 (100.0)

Numbness 21 (84.0)

Pulse loss 17 (68.0)

Cold skin 9 (36.0)

Ulcer 6 (24.0)

Vertigo 6 (24.0)

Pale skin 2 (8.0)

Weakness 2 (8.0)

Length of follow-up (months) 43 (37; 48)

TABLE 1: Patient characteristics

Summary statistics are n (%), mean ± standard deviation (min; max), and median (25th; 75th percentiles).

CAD, coronary artery disease; PAD, peripheral arterial disease

Table 2 displays the lesion characteristics as assessed by CTA. The majority of patients (76%) had the main
lesion located in the left subclavian artery. Most of the lesions were restricted to the proximal segment only
(76% of patients), while in 20% of patients, the lesions extended from the proximal to medial segment, and
in 4% of patients, the lesion involved the entire subclavian artery. The severity of most lesions (64%) was
evaluated as stenosis ranging from 70% to 95%, whereas 20% of lesions were assessed as occlusions.

2023 Van Nut et al. Cureus 15(9): e44699. DOI 10.7759/cureus.44699 4 of 10

 All patients (N=25)

Side

Left 19 (76.0)

Right 6 (24.0)

Lesion location

Proximal only 19 (76.0)

Proximal to medial 5 (20.0)

Proximal to distal 1 (4.0)

Lesion severity

Stenosis 70-95% 16 (64.0)

Stenosis 96-99% 4 (16.0)

Occlusion 5 (20.0)

TABLE 2: Lesion characteristics

Summary statistics are n (%).

Table 3 presents the procedural characteristics of the endovascular treatments. The majority of procedures
(88%, 22 cases) were performed under local anesthesia, while in the remaining three patients (12%), the
procedure was conducted under general anesthesia. The mean operating time for the procedures was 71.6
minutes, ranging from 40 to 120 minutes. In 20 patients (80%), successful retrograde access was achieved
through the ipsilateral brachial artery. However, in the remaining five patients (20%), retrograde access was
not feasible, and the antegrade approach through the femoral artery access was utilized. The lesion
characteristics assessed intraoperatively were consistent with those assessed by CTA, with most lesions
(76%, 19 cases) located in the proximal segment only, and the majority being classified as stenosis (76%, 19
cases).

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 All patients (N=25)

Anesthesia

Local anesthesia 22 (88.0)

General anesthesia 3 (12.0)

Operating time (mins) 71.6 ± 20.1 (40; 120)

Accessed site

Ipsilateral brachial artery 20 (80.0)

Femoral artery 5 (20.0)

Lesion location

Proximal only 19 (76.0)

Proximal to medial 4 (16.0)

Proximal to distal 2 (8.0)

Lesion severity

Stenosis 70-95% 12 (48.0)

Stenosis 96-99% 7 (28.0)

Occlusion 6 (24.0)

Complications 2 (8.0)

Postoperative hospital length of stay (days) 3.0 ± 0.7 (2; 5)

Technical success 24 (96.0)

TABLE 3: Procedural characteristics

Summary statistics are n (%) and mean ± standard deviation (min; max).

During the procedures, two complications occurred, both in the form of hematoma at the accessed site,
specifically at the brachial artery. In both cases, puncture-focused compression was successfully performed,
and the hematomas were resolved within 24 hours. Overall, technical success was achieved in 96% of
procedures (24 out of 25). Only one procedure was considered a failure due to a residual stenosis of more
than 30% as revealed by intraoperative angiography after stenting. In an attempt to address in-stent
stenosis, balloon angioplasty was performed but proved unsuccessful. This particular lesion was an
occlusion located at the whole subclavian artery. Despite the failure to completely address the stenosis, the
clinical symptoms of this patient showed improvement postoperatively.

Table 4 illustrates the significant improvement in clinical symptoms right after treatment when compared
with before treatment. The most notable improvements were observed in arm claudication (reduced from
100% before treatment to 24% after treatment), numbness (reduced from 84% to 24%), and pulse loss
(decreased from 68% to 4%). Only weakness did not show immediate improvement before discharge and
required more time for resolution.

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 Before treatment (N=25) After treatment (N=25)

Arm claudication 25 (100.0) 6 (24.0)

Numbness 21 (84.0) 6 (24.0)

Pulse loss 17 (68.0) 1 (4.0)

Cold skin 9 (36.0) 2 (8.0)

Ulcer 6 (24.0) 3 (12.0)

Vertigo 6 (24.0) 2 (8.0)

Pale skin 2 (8.0) 1 (4.0)

Weakness 2 (8.0) 2 (8.0)

TABLE 4: Symptoms before and after intervention

Summary statistics are n (%).

Over the median follow-up period of 43 months, there were no recorded cardiac or neurologic events, nor
any deaths. However, restenosis of the subclavian artery was observed in two patients, one at six months
and the other at 13 months after the intervention. Notably, the patient with restenosis detected at six
months was the one with the technical failure described earlier. The Kaplan-Meier probability of freedom
from restenosis was 96% at 1 year, 92% at 2 years, and 92% at three years (Figure 1).

FIGURE 1: Kaplan-Meier curves for subclavian artery patency

The line represents the Kaplan-Meier estimate, and the grey region represents the 95% confidence interval.

Discussion
The findings of this study highlight the safety and efficacy of endovascular treatment for subclavian artery
diseases, with a low rate of minor complications (8%) and an overall excellent clinical success rate of 96%.
The long-term patency rate, which remained above 90% after four years, further supports the positive
outcomes of this intervention.

Percutaneous balloon angioplasty with stenting is a widely recognized approach for treating subclavian

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 stenosis or occlusion. However, it appears to be less effective for occlusive lesions, as it has a lower success
rate. In our study, the only technical failure case had an occlusive lesion that was located at the whole
subclavian artery. Previous research demonstrated that the technical success rate was notably lower in
patients with subclavian occlusions compared to those with stenosis lesions [17,21]. This is primarily
attributed to the challenges posed by severe calcification and tortuosity of the subclavian arteries.
Fortunately, the advancement of endovascular devices has provided new opportunities and indications for
minimally invasive treatments in patients with occlusive diseases. While stent-supported angioplasty has
been favored since the 1990s to avoid recoil and reduce the risk of recurrence, there is still a lack of
randomized trials to definitively determine the superiority of stenting over plain angioplasty without
stenting [22]. Some studies have shown potential advantages of stenting, while others reported no
significant differences between the treatment strategies [23,24]. It is important to note that the decision to
use stenting should consider factors such as lesion characteristics, the extent of calcification, and the
presence of vascular dissections.

The overall complication rate observed in our study was low, with only two cases of minor hematomas at the
accessed site. Importantly, no instances of embolization to the brain or limb were observed during the
procedure. This finding aligns with previous literature, which consistently reports a low risk of cerebral or
limb embolization, ranging from 0 to 5.7% [14,25,26]. While the number of embolic events remains small,
access-site complications are more commonly encountered. As previously reported, using the brachial artery
as the access site is associated with a higher incidence of complications compared to the femoral artery [27].
In our study, we also observed a significant increase in local adverse events when the brachial artery was
used for access. An alternative option, the radial approach, which is commonly employed in coronary
angiography, has been shown to have a lower access site complication rate. However, our department has
limited experience with the radial approach in supra-aortic interventions thus far. For the majority of cases,
femoral access with an antegrade procedure remains the preferred approach and is used as the primary
option. Nevertheless, in certain cases, especially in the setting of total chronic occlusions, a combined
approach with additional retrograde access can be crucial for achieving technical success. This approach
allows for a double injection technique and the usage of guidewires in both directions, which can be
advantageous in challenging cases.

During the follow-up period, our study demonstrated a low overall rate of restenosis, with a 92% patency
rate at the three-year mark. These findings are in line with previous observational studies that reported
primary patency rates ranging from 70% to 90% after two years [14,25,27]. Importantly, these patency rates
are comparable to those reported after surgical interventions, reaffirming the effectiveness and durability of
endovascular therapy as an alternative to surgery for subclavian artery diseases. For instance, in a
retrospective study involving 110 patients with subclavian artery steno-occlusive disease treated by
percutaneous angioplasty, the three-year patency rate was achieved in 93% of patients with subclavian
stenoses and 65% of patients with occlusions [25].

Despite these positive findings, our study does have certain limitations. First, being a retrospective study
conducted in a referral center, ensuring consistent follow-up for patients from different regions of Vietnam
was challenging. Secondly, the sample size was relatively small, and there was no comparison group, mainly
due to the low prevalence and incidence of symptomatic subclavian artery disease. As a result, future studies
with larger sample sizes, longer follow-up durations, and comparison groups are essential and may provide
additional data that could potentially influence or refine our current conclusions.

Conclusions
Our retrospective single-center study has demonstrated that endovascular treatment for subclavian artery
stenosis and occlusion is not only safe but also highly effective, yielding excellent long-term patency rates.
These results are consistent with previous reports and add further evidence to support percutaneous
revascularization as the preferred first-line therapy for these conditions. However, it is important to
acknowledge that further studies with larger sample sizes and longer follow-up periods are needed to
confirm and validate these findings.

Additional Information
Disclosures
Human subjects: Consent was obtained or waived by all participants in this study. Ethics Committee of the
University of Medicine and Pharmacy at Ho Chi Minh City issued approval 540/HĐĐĐ-ĐHYD. Ethical
approval for this study was obtained from the Ethics Committee of the University of Medicine and Pharmacy
at Ho Chi Minh City (Approval No. 540/HĐĐĐ-ĐHYD, dated 2 June 2022). Animal subjects: All authors
have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In
compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services
info: All authors have declared that no financial support was received from any organization for the
submitted work. Financial relationships: All authors have declared that they have no financial
relationships at present or within the previous three years with any organizations that might have an
interest in the submitted work. Other relationships: All authors have declared that there are no other
relationships or activities that could appear to have influenced the submitted work.

2023 Van Nut et al. Cureus 15(9): e44699. DOI 10.7759/cureus.44699 8 of 10

 Acknowledgements
We acknowledge all the patients who participated in this study and the medical staff who helped in their
management at Cho Ray Hospital.

References
1. English JA, Carell ES, Guidera SA, Tripp HF: Angiographic prevalence and clinical predictors of left
subclavian stenosis in patients undergoing diagnostic cardiac catheterization. Catheter Cardiovasc Interv.
2001, 54:8-11. 10.1002/ccd.1230
2. Shadman R, Criqui MH, Bundens WP, Fronek A, Denenberg JO, Gamst AC, McDermott MM: Subclavian
artery stenosis: prevalence, risk factors, and association with cardiovascular diseases. J Am Coll Cardiol.
2004, 44:618-23. 10.1016/j.jacc.2004.04.044
3. Gutierrez GR, Mahrer P, Aharonian V, Mansukhani P, Bruss J: Prevalence of subclavian artery stenosis in
patients with peripheral vascular disease. Angiology. 2001, 52:189-94. 10.1177/000331970105200305
4. Ishihara T, Haraguchi G, Tezuka D, Kamiishi T, Inagaki H, Isobe M: Diagnosis and assessment of Takayasu
arteritis by multiple biomarkers. Circ J. 2013, 77:477-83. 10.1253/circj.cj-12-0131
5. Ohigashi H, Haraguchi G, Konishi M, Tezuka D, Kamiishi T, Ishihara T, Isobe M: Improved prognosis of
Takayasu arteritis over the past decade--comprehensive analysis of 106 patients. Circ J. 2012, 76:1004-11.
10.1253/circj.cj-11-1108
6. Ishida T, Ishida M, Tashiro S, Yoshizumi M, Kihara Y: Role of DNA damage in cardiovascular disease . Circ J.
2014, 78:42-50. 10.1253/circj.cj-13-1194
7. Cua B, Mamdani N, Halpin D, Jhamnani S, Jayasuriya S, Mena-Hurtado C: Review of coronary subclavian
steal syndrome. J Cardiol. 2017, 70:432-7. 10.1016/j.jjcc.2017.02.012
8. Criqui MH, Fronek A, Barrett-Connor E, Klauber MR, Gabriel S, Goodman D: The prevalence of peripheral
arterial disease in a defined population. Circulation. 1985, 71:510-5. 10.1161/01.cir.71.3.510
9. Anegawa T, Kai H, Fukuda K, et al.: Respiratory variation of vertebral arterial flow in a patient scheduled for
coronary artery bypass graft surgery: lesson from atypical subclavian steal phenomenon. Circ J. 2013,
77:2412-4. 10.1253/circj.cj-13-0071
10. Stone PA, Srivastiva M, Campbell JE, Mousa AY: Diagnosis and treatment of subclavian artery occlusive
disease. Expert Rev Cardiovasc Ther. 2010, 8:1275-82. 10.1586/erc.10.111
11. 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,
32:411-8; discussion 418-9. 10.1067/mva.2000.108644
12. Aboyans V, Ricco JB, Bartelink ME, et al.: 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral
Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document
covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower
extremity arteries Endorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis
and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the
European Society for Vascular Surgery (ESVS). Eur Heart J. 2018, 39:763-816. 10.1093/eurheartj/ehx095
13. Saha T, Naqvi SY, Ayah OA, McCormick D, Goldberg S: Subclavian artery disease: diagnosis and therapy . Am
J Med. 2017, 130:409-16. 10.1016/j.amjmed.2016.12.027
14. Sixt S, Rastan A, Schwarzwälder U, et al.: Results after balloon angioplasty or stenting of atherosclerotic
subclavian artery obstruction. Catheter Cardiovasc Interv. 2009, 73:395-403. 10.1002/ccd.21836
15. Babic S, Sagic D, Radak D, et al.: Initial and long-term results of endovascular therapy for chronic total
occlusion of the subclavian artery. Cardiovasc Intervent Radiol. 2012, 35:255-62. 10.1007/s00270-011-0144-
8
16. Bradaric C, Kuhs K, Groha P, et al.: Endovascular therapy for steno-occlusive subclavian and innominate
artery disease. Circ J. 2015, 79:537-43. 10.1253/circj.CJ-14-0855
17. Karpenko A, Starodubtsev V, Ignatenko P, Gostev A: Endovascular treatment of the subclavian artery steno-
occlusive disease. J Stroke Cerebrovasc Dis. 2017, 26:87-93. 10.1016/j.jstrokecerebrovasdis.2016.08.034
18. Benhammamia M, Mazzaccaro D, Ben Mrad M, Denguir R, Nano G: Endovascular and surgical management
of subclavian artery occlusive disease: early and long-term outcomes. Ann Vasc Surg. 2020, 66:462-9.
10.1016/j.avsg.2019.11.041
19. Schneider V, Dirschinger R, Wustrow I, et al.: Endovascular therapy of subclavian artery occlusive disease
involving the vertebral artery origin. Vasa. 2020, 49:205-13. 10.1024/0301-1526/a000842
20. Mrad IB, Miri R, Mazzaccaro D, et al.: Endovascular therapy for steno-occlusive subclavian artery disease
early and long-term outcomes in a multicentric Tunisian study. Ann Ital Chir. 2022, 93:470-5.
21. Linni K, Ugurluoglu A, Mader N, Hitzl W, Magometschnigg H, Hölzenbein TJ: Endovascular management
versus surgery for proximal subclavian artery lesions. Ann Vasc Surg. 2008, 22:769-75.
10.1016/j.avsg.2008.08.001
22. Burihan E, Soma F, Iared W: Angioplasty versus stenting for subclavian artery stenosis . Cochrane Database
Syst Rev. 2011, CD008461. 10.1002/14651858.CD008461.pub2
23. Bates MC, Broce M, Lavigne PS, Stone P: Subclavian artery stenting: factors influencing long-term outcome .
Catheter Cardiovasc Interv. 2004, 61:5-11. 10.1002/ccd.10711
24. Henry M, Amor M, Henry I, Ethevenot G, Tzvetanov K, Chati Z: Percutaneous transluminal angioplasty of
the subclavian arteries. J Endovasc Surg. 1999, 6:33-41.
25. De Vries JP, Jager LC, Van den Berg JC, Overtoom TT, Ackerstaff RG, Van de Pavoordt ED, Moll FL:
Durability of percutaneous transluminal angioplasty for obstructive lesions of proximal subclavian artery:
long-term results. J Vasc Surg. 2005, 41:19-23. 10.1016/j.jvs.2004.09.030
26. Mordasini P, Gralla J, Do DD, et al.: Percutaneous and open retrograde endovascular stenting of
symptomatic high-grade innominate artery stenosis: technique and follow-up. AJNR Am J Neuroradiol.
2011, 32:1726-31. 10.3174/ajnr.A2598
27. Berger L, Bouziane Z, Felisaz A, Coffin O, Dugue A, Maiza D: Long-term results of 81 prevertebral subclavian

2023 Van Nut et al. Cureus 15(9): e44699. DOI 10.7759/cureus.44699 9 of 10

 artery angioplasties: a 26-year experience. Ann Vasc Surg. 2011, 25:1043-9. 10.1016/j.avsg.2011.03.017

2023 Van Nut et al. Cureus 15(9): e44699. DOI 10.7759/cureus.44699 10 of 10