engleski

Endovascular treatment of subclavian stenosis – single center experience

Introduction: Subclavian artery stenosis is a potential cause of serious morbidity, endangering the upper extremities, brain and the heart. It is a relatively rare form of peripheral arterial disease, usually present in patients who already suffer from peripheral arterial disease on other vessels, most often lower extremity arteries. Atherosclerosis is considered to be the primary underlying cause. The current treatment of choice is endovascular approach which combines percutaneous transluminal angioplasty and stenting as its noninvasive nature yields faster recovery and less complications. Aim: The aim of this study was to examine the characteristics of subclavian atherosclerotic lesions in patients who underwent endovascular procedure and their relationship with known risk factors. Additional aim was to assess clinical and procedure characteristics of patients and compare them with similar experiences from other centers. Patients and methods: We conducted a retrospective single center review of patients treated with endovascular procedure for SA stenosis and/or occlusion. A total of 53 patients were detected. Three patients were excluded due to the arteritis origin of the stenosis, leaving 50 patients suitable for analysis. Participants’ characteristics were analyzed using descriptive statistics. Normal distribution was assessed using Shapiro-Wilk test. Categorical variables were analyzed using the Chi-square test. Univariate logistic regression was used to calculate unadjusted odds ratios of factors associated with level of stenosis. Results: The mean age at the time of the first intervention was 62±8 years. All except 8 patients were symptomatic. The most common symptoms were paresthesia (32%), vertigo (30%), muscle fatigue (24%) and rest pain (22%). 58% of patients presented with Subclavian steal syndrome. The most common comorbidities and risk factors present in selected patients were hypertension 76%, smoking 60%, hyperlipidemia 60% and coronary artery disease 22%. A total of 50 lesions were treated with 59 endovascular procedures, 9 reinterventions among them. Technical success was achieved in 85% of procedures. After univariate analysis 3 items were detected suitable for multivariate logistic regression. The multivariate regression model was statistically significant χ2 (4, N = 50) = 17.94, p <0.01, explaining 42.7% of variance (Nagelkerke R2 = .427). Female gender (p<0.05), hypertension (p<0.05) and smoking status (p<0.05) were independently associated with occlusion. Women had 7.7 times the odds of developing occlusion compared to males. Moreover, patients with a history of hypertension were 5.1 times more likely to develop occlusion. Smoking was associated with 7.8 higher chances to develop occlusion. The results of multivariate analysis are of limited significance due to the small sample size.Conclusion: Comparing this review with other similar studies, most of the clinical and demographic indicators were inconspicuous. Technical success was achieved in 85% of the procedures in our center, whereas in other studies it was markedly higher, ranging from 93% to 98%. Female gender was identified as an additional independent risk factor, although the relevant literature indicates male gender as the risk factor. Although hyperlipidemia is a known risk factor for atherosclerotic stenosis, it did not reach statistical significance in univariate analysis. This research provided a much needed insight into the characteristics of patients and effectiveness of interventions undertaken in our center.

subclavian stenosis ; subclavian artery ; occlusion ; endovascular intervention ; hypertension ; gender ; smoking ; hyperlipidemia ; stenting ; angioplasty

nije evidentirano