Retrospective Analysis Of 23 Patients With Chronic Subclavian Artery Occlusion Treated By Interventional Recanalization

Objective 1.To investigate the necessity,feasibility,safety and effectiveness of interventional recanalization in patients with chronic subclavian artery occlusion.2.To investigate the influence of different morphological types of patients with chronic subclavian artery occlusion on the success rate and safety of interventional recanalization therapy.Methods The clinical data of patients with chronic subclavian artery occlusion admitted to the General Hospital of Ningxia Medical University from January 2014 to July 2020 were retrospectively analyzed,including demographic characteristics,vascular risk factors,success rate of interventional recanalization technique,perioperative complications and follow-up.Results A total of 23 cases were collected,including 16 males(69.6%)and 7 females(30.4%),aged 45-78 years,with an average age of(64.3±9.3)years.There were 14 cases of hypertension(60.1%),8 cases of diabetes mellitus(34.8%),7 cases of coronary heart disease(30.4%),and 6 cases of abnormal lipid metabolism(26.1%).11 cases(47.8%)smoked and 9cases(39.1%)drank.Atherosclerosis was considered as the etiology in all patients.Clinical manifestations: posterior circulation ischemia in 18 cases(78.3%),upper limb ischemia in 1case(4.3%),and coexistence of the two(17.4%);There were 18 cases(78.3%)on the left side and 5 cases(21.7%)on the right side.All the 23 patients showed signs of subclavian artery stealing blood,and there were 7 ways of stealing blood.Fifteen of the 23 patients with chronic subclavian artery occlusion were successfully recanalized,the technical success rate was 65.2%(15/23),the hemodynamic success rate and the clinical success rate were both 65.2%(15/23).Then pass the side: the left side succeeded80%(12/15),the right side succeeded 20%(3/15);Re-access approach: the first femoral artery approach was successfully opened 80%(12/15);20%(3/15)of the patients were first opened through the radial artery approach.Surgical methods: direct balloon dilatation molding(6.7%,1/15),balloon dilatation + stent implantation molding(93.3%,14/15);A total of 18 stents were implanted,and the types of stents were: spherical expansion stents 64.3%(9/14),self-expanding stents 7.1%(1/14),spherical expansion + self-expanding stents 21.4%(3/14),and spherical expansion + spherical expansion stents 7.1%(1/14).30 days perioperative complications: the incidence of complications was 43.5%(10/23),asymptomatic 39.1%(9/23)and symptomatic 4.3%(1/23),presenting as chest pain;Treatment of vascular related complications 39.1%(9/23): affected side vertebral artery occlusion 4.3%(1/23);Subclavian artery dissection(26.1%,6/23)disappeared after stent placement,aortic dissection(8.7%,2/23)disappeared in 1 case after stent placement,and another case was reexamined for dissection 10 months after secondary interventional therapy.Other complications: contrast encephalopathy(4.3%,1/23)(carotid artery stent implantation);There were no operation-related deaths or permanent neurological deficits.Postoperative vascular follow-up:10 cases were followed up(43.5%),5 cases were followed up by CTA(21.7%),3 cases were followed up by cervical vascular ultrasound(13.1%),and 2 cases were followed up by CTA+cervical vascular ultrasound(8.7%).During follow-up,restenosis occurred in 1 patient(4.3%).The initial segment of subclavian artery occlusion was successfully opened by femoral artery for the first time in 12 cases(43.5%): 100%(2/2)of rat tail type;Peaked type 66.7%(2/3);Hilly type 54.5%(6/11);Plain type 28.6%(2/7).30 days perioperative complication rate:rat tail type 0%(0/2);Peaked type 66.7%(2/3);Hilly type 45.4%(5/11);Plain type 42.9%(3/7).Three cases(13%)of the subclavian artery were successfully opened for the first time via the radial artery approach: rat tail type(100%(1/1);Peaked type 16.7%(1/6);Hilly type8.3%(1/12);Plain type 0%(0/4).30 days perioperative complication rate: rat tail type 0%(0/1);Peak type 50%(3/6);Hilly type 41.7%(5/12);Flat type 50%(2/4).All patients were analyzed according to different combinations of the two types of angiography(whether the type belonged to the initial segment or the reflux segment).The success rate of rat tail type+any of the typing techniques was 100%(3/3).The technical success rate of spike type+any type(except rat tail type)was 85.7%(6/7).The technical success rate of hilly type+any type(except rat tail type and sharp peak type)is 50%(6/12);Plain+plain technique success rate 0%(0/1).Conclusion 1.Interventional recanalization of chronic subclavian artery occlusion may be a safe and effective treatment method.2.Different types of patients with chronic subclavian artery occlusion may have certain influence on the success rate and safety of interventional recanalization therapy.