Endovascular Treatment of Subclavian Artery Stenosis From the Perspective of the Cardiologist: A Tertiary Health Center Experience

Özdemir, Emre; Karagöz, Uğur; Nazlı, Cem; emren, volkan; Tokaç, Mehmet

Endovascular Treatment of Subclavian Artery Stenosis From the Perspective of the Cardiologist: A Tertiary Health Center Experience

Emre ÖZDEMİR, (Katip Çelebi Üniversitesi, Atatürk Eğitimi ve Araştırma Hastanesi, Kardiyoloji Kliniği, İzmir, Türkiye)

SADIK VOLKAN EMREN, (Katip Çelebi Üniversitesi, Atatürk Eğitimi ve Araştırma Hastanesi, Kardiyoloji Kliniği, İzmir, Türkiye)

Cem NAZLI, (Katip Çelebi Üniversitesi, Atatürk Eğitimi ve Araştırma Hastanesi, Kardiyoloji Kliniği, İzmir, Türkiye)

Mehmet TOKAÇ, (Katip Çelebi Üniversitesi, Atatürk Eğitimi ve Araştırma Hastanesi, Kardiyoloji Kliniği, İzmir, Türkiye)

Uğur KARAGÖZ (Katip Çelebi Üniversitesi, Atatürk Eğitimi ve Araştırma Hastanesi, Kardiyoloji Kliniği, İzmir, Türkiye)

Ege Klinikleri Tıp Dergisi

2 1

Yıl: 2019 Cilt: 57 Sayı: 2 Sayfa Aralığı: 81 - 85 Metin Dili: İngilizce İndeks Tarihi: 24-10-2020

Endovascular Treatment of Subclavian Artery Stenosis From the Perspective of the Cardiologist: A Tertiary Health Center Experience

Öz:

Aim: Subclavian artery disease(SAD) has a prevalence of ~2%. Patients canhave various symptoms due to ischemia despite medical treatment and theyshould be treated endovascularly or surgically. The aim of this study was toreport the treatment outcomes of cases applied with endovascular SADrevascularization in a tertiary cardiology center from Turkey.Method: The study included 51 patients who underwent subclavianangiography due to symptomatic SAD in our hospital. All data related to themedical information, balloon and stent sizes, treatment decision, and followup period of the patients were retrieved from the data recording system of ourhospital.Results: The patients comprised 37(72%) males. The indications forintervention were ischemia of the extremity (arm) in 11.8%(n:6), subclaviansteal syndrome in 64.7%(n:33), posterior cerebral ischemic event in 15.7%(n:8),and ischemia of coronary by LIMA in 3.9%(n:2). The mean vessel diameter was8.25±1.1 mm and the mean stenosis rate was 89.02±10.28%. Self-expandablestents were used in 29.4% of the patients. The diseased artery was leftsubclavian in 38(74.5%) patients. Medical follow-up was decided for 8(15.4%)patients due to non-critical lesions on angiography. 75%(n: 39) of patientssuccessfully treatment with endovascular procedures(PTA) was applied to39(75%) patients, surgery could not be performed to 3(5.8%) patients becauseof unsuitable anatomic features, and the PTA prcoedure failed in 2(3.8%)patients. The success rate was determined as 88.6% (39 of 44 patients).Conclusion: Angioplasty and stenting of SAD was successful in the long term,for focal lesions with high success rates when performed by cardiologists inexperienced centers.

Anahtar Kelime:

Subklaviyan Arter Darlığının Kardiyolog Bakış Açısıyla Endovasküler Tedavisi: Üçüncü Basamak Klinik Deneyimi

Öz:

Amaç: Subklaviyen arter hastalığı (SAD), ~% 2 prevalansına sahiptir. Hastalar iskemi nedeniyle, medikal tedaviye rağmen, çeşitli semptomlar gösterebilir. SAD endovasküler veya cerrahi olarak tedavi edilebilir. Çalışmamızın amacı, Türkiye'de bir üçüncü basamak merkezde perkütan SAD revaskülarizasyonu olguların tedavi sonuçlarını bildirmektir. Metod: Çalışmaya hastanemizde semptomatik SAD nedeniyle subklaviyan anjiyografi yapılan 51 hasta dahil edildi. Tıbbi bilgiler, balon ve stent büyüklükleri, tedavi kararı ve hastaların takip süresi ile ilgili tüm veriler hastanemiz veri kayıt sisteminden alınmıştır. Sonuç: Hastalarımızın %72'si erkekten oluşuyordu. Müdahale endikasyonları %11.8(n:6)'inde ekstremite (kol) iskemisi, %64.7(n:8)'inde subklaviyan çalma sendromu, %15.7(n: 8)'sinde posterior serebral iskemik olay ve %3.9(n: 2)'unda LIMA- koroner bypass nedenli koroner iskemiydi. Ortalama damar çapı 8,25 ± 1,1 mm ve ortalama darlık oranı %89,02 ± 10,28 idi. Kendiliğinden açılır stentler hastaların %29,4’ünde kullanılmıştır. Hastalıklı arter 38 hastada (%74.5) sol subklavyen olarak saptandı. Anjiyografide kritik olmayan lezyonlar nedeniyle 8 (%15.4) hastaya tıbbi takip kararı verildi. Hastaların %75(n: 39)'i endovasküler yolla başarılı bir şekilde tedavi edildi, uygun olmayan anatomik özelliklerden dolayı 3(%5.8) hastanın işlemi yapılamadı ve 2(%3.8) hastada işlem denendi ama başarısız oldu. Başarı oranı % 88.6 (44 hastada 39 hasta) olarak belirlendi. Sonuç: SAD'nin anjiyoplasti ve stentlenmesi, kardiyologlar tarafından deneyimli merkezlerde yapıldığında yüksek başarı oranlarına sahiptir ve fokal lezyonlar için , uzun vadede başarılı olmaktadır

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1.Przewlocki T, Kablak-Ziembicka A, Pieniazek P, Musialek P, Kadzielski A, Zalewski J. et al. Determinants of immediate and long-term results of subclavian and innominate artery angioplasty. Cathet Cardiovasc Intervent. 2006; 67: 519-526.
2.Abu Rahma AF, Bates MC, Stone PA, Dyer B, Armistead L, Scott Dean L, et al. Angioplasty and stenting versus carotidsubclavian bypass for the treatment of isolated subclavian artery disease. J Endovasc Ther. 2007; 14: 698-704.
3. Palchik E, Bakken AM, Wolford HY, Saad WE, Davies MG. Subclavian artery revascularization: an outcome analysis based on mode of therapy and presenting symptoms. Ann Vasc Surg. 2008; 22: 70-78
4.Janjic M, Saratzis N, Voulalas G, Lazaridis I, Karamanos D, et al. Endovascular Treatment of Subclavian Artery Lesions. Global Journal of Angiology 2015; 1: 1-5.
5.Shadman R, Criqui MH, Bundens WP, Fronek A, Denenberg JO, et al. Subclavian artery stenosis: prevalence, risk factors, and association with cardiovascular diseases. J Am Coll Cardio 2004;44:618-23
6.Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD et al. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM /SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: J Am Coll Cardio2011; 57(8): e16-94.
7.Ochoa VM and Yeghiazarians Y. Subclavian artery stenosis: a review for the vascular medicine practitioner. Vascular medicine. 2011;16:29- 34.
8.Palchik E, Bakken AM, Wolford HY, Saad WE, Davies MG. Subclavian artery revascularization: an outcome analysis based on mode of therapy and presenting symptoms. Ann Vasc Surg. 2008; 22: 70-8
9.Houbballah R, Jamal JH. Subclavian Artery Angioplasty Stenting. Operative Dictations in General and Vascular Surgery 2012;1: 700-2
10.Iared W, Mourão JE, Puchnick A, Soma F, Shigueoka DC. Angioplasty versus stenting for subclavian artery stenosis. The Cochrane Library 2014;10
11.Saha T, Naqvi SY, Ayah OA, McCormick D, Goldberg S.Subclavian artery disease: diagnosis and therapy.Am J Med. 2017; 130(4): 409-16.
12.Mousa AY, AbuRahma AF, Bozzay J, Broce M, Barsoum E, Bates M. Anatomic and clinical predictors of reintervention after subclavian arterystenting, J. Vasc. Surg. 2015; 15 106-14
13.Körner M, Baumgartner I, Do DD, Mahler F, Schroth G. PTA of the subclavian and innominate arteries: long-term results. VASA 1999; 28: 117-22
14.Bogey WM, Demasi RJ, Tripp MD, Vithalani R, Johnsrude IS, Powel SC. Percutaneous transluminal angioplasty for subclavian artery stenosis. Am Surg. 1994; 60: 103-6.
15.Brountzos EN, Petersen B, Binkert C, Panagiotou I, Kaufman JA. Primary stenting of subclavian and innominate artery occlusive disease: a single center's experience. Cardiovasc Intervent Radiol. 2004;27:616-23
16.Bachman DM, Kim RM. Transluminal dilatation for subclavian steal syndrome. AJR Am J Roentgenol. 1980;135(5):95–6.
17.Palmaz JC, Kopp DT, Hayashi H, Schatz RA, Hunter G, Tio FO, et al.Normal and stenotic renal arteries: experimental balloonexpandable intraluminal stenting. Radiology 1987;164(3):705–8

APA	Özdemir E, emren v, Nazlı C, Tokaç M, Karagöz U (2019). Endovascular Treatment of Subclavian Artery Stenosis From the Perspective of the Cardiologist: A Tertiary Health Center Experience. , 81 - 85.
Chicago	Özdemir Emre,emren volkan,Nazlı Cem,Tokaç Mehmet,Karagöz Uğur Endovascular Treatment of Subclavian Artery Stenosis From the Perspective of the Cardiologist: A Tertiary Health Center Experience. (2019): 81 - 85.
MLA	Özdemir Emre,emren volkan,Nazlı Cem,Tokaç Mehmet,Karagöz Uğur Endovascular Treatment of Subclavian Artery Stenosis From the Perspective of the Cardiologist: A Tertiary Health Center Experience. , 2019, ss.81 - 85.
AMA	Özdemir E,emren v,Nazlı C,Tokaç M,Karagöz U Endovascular Treatment of Subclavian Artery Stenosis From the Perspective of the Cardiologist: A Tertiary Health Center Experience. . 2019; 81 - 85.
Vancouver	Özdemir E,emren v,Nazlı C,Tokaç M,Karagöz U Endovascular Treatment of Subclavian Artery Stenosis From the Perspective of the Cardiologist: A Tertiary Health Center Experience. . 2019; 81 - 85.
IEEE	Özdemir E,emren v,Nazlı C,Tokaç M,Karagöz U "Endovascular Treatment of Subclavian Artery Stenosis From the Perspective of the Cardiologist: A Tertiary Health Center Experience." , ss.81 - 85, 2019.
ISNAD	Özdemir, Emre vd. "Endovascular Treatment of Subclavian Artery Stenosis From the Perspective of the Cardiologist: A Tertiary Health Center Experience". (2019), 81-85.

APA	Özdemir E, emren v, Nazlı C, Tokaç M, Karagöz U (2019). Endovascular Treatment of Subclavian Artery Stenosis From the Perspective of the Cardiologist: A Tertiary Health Center Experience. Ege Klinikleri Tıp Dergisi, 57(2), 81 - 85.
Chicago	Özdemir Emre,emren volkan,Nazlı Cem,Tokaç Mehmet,Karagöz Uğur Endovascular Treatment of Subclavian Artery Stenosis From the Perspective of the Cardiologist: A Tertiary Health Center Experience. Ege Klinikleri Tıp Dergisi 57, no.2 (2019): 81 - 85.
MLA	Özdemir Emre,emren volkan,Nazlı Cem,Tokaç Mehmet,Karagöz Uğur Endovascular Treatment of Subclavian Artery Stenosis From the Perspective of the Cardiologist: A Tertiary Health Center Experience. Ege Klinikleri Tıp Dergisi, vol.57, no.2, 2019, ss.81 - 85.
AMA	Özdemir E,emren v,Nazlı C,Tokaç M,Karagöz U Endovascular Treatment of Subclavian Artery Stenosis From the Perspective of the Cardiologist: A Tertiary Health Center Experience. Ege Klinikleri Tıp Dergisi. 2019; 57(2): 81 - 85.
Vancouver	Özdemir E,emren v,Nazlı C,Tokaç M,Karagöz U Endovascular Treatment of Subclavian Artery Stenosis From the Perspective of the Cardiologist: A Tertiary Health Center Experience. Ege Klinikleri Tıp Dergisi. 2019; 57(2): 81 - 85.
IEEE	Özdemir E,emren v,Nazlı C,Tokaç M,Karagöz U "Endovascular Treatment of Subclavian Artery Stenosis From the Perspective of the Cardiologist: A Tertiary Health Center Experience." Ege Klinikleri Tıp Dergisi, 57, ss.81 - 85, 2019.
ISNAD	Özdemir, Emre vd. "Endovascular Treatment of Subclavian Artery Stenosis From the Perspective of the Cardiologist: A Tertiary Health Center Experience". Ege Klinikleri Tıp Dergisi 57/2 (2019), 81-85.