Abstract
The subclavian and innominate arteries provide arterial supply to the upper extremities and to parts of the intracranial vasculature. This chapter reviews key anatomic features and variations, and different types of disease processes affecting these vessels. Diagnostic strategies including clinical history, physical examination findings, and use of noninvasive tools are discussed. This chapter also reviews the indications for treating subclavian disease including important clinical entities such as subclavian steal and coronary–subclavian steal syndromes. Different treatment options including surgery (such as carotid–subclavian bypass) and endovascular approaches are discussed. Of note, surgical treatment remains the definitive treatment of thoracic outlet syndrome. This chapter also addresses important concepts in angiography of the upper extremity arteries, treatment strategies, as well as the different types of equipment (balloon-expandable vs. self-expanding stents) and techniques (e.g., telescoping access technique) available in modern practice. Key concepts include recognition of the importance of aortic arch anatomy in determining guide or sheath selection; and identification of the origins of key branches (internal mammary and vertebral arteries), which may be affected by stenting of the subclavian artery. The role of retrograde recanalization via a brachial or radial approach is also discussed. Finally, procedural outcomes and complications are reviewed.
Keywords
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Natsis KI, Tsitouridis IA, Didagelos MV, Fillipidis AA, Vlasis KG, Tsikaras PD. Anatomical variations in the branches of the human aortic arch in 633 angiographies: clinical significance and literature review. Surg Radiol Anat. 2009;31:319–323.
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 Interven. 2001;54:8–11.
Osborn LA, Vernon SM, Reynolds B, Timm TC, Allen K. Screening for subclavian artery stenosis in patients who are candidates for coronary bypass surgery. Catheter Cardiovasc Interven. 2002;56:162–165.
Moussa F, Kumar P, Pen V. Cardiac CT scan for preoperative planning in a patient with bilateral subclavian stenosis needing coronary artery bypass. J Card Surg. 2009;24:196–197.
Peloschek P, Sailer J, Loewe C, Schillinger M, Lammer J. The role of multi-slice spiral CT angiography in patient management after endovascular therapy. Cardiovasc Intervent Radiol. 2006;29:756–761.
Remy-Jardin M, Remy J, Masson P, et al. Helical CT angiography of thoracic outlet syndrome: functional anatomy. AJR Am J Roentgenol. 2000;174:1667–1674.
Bitar R, Gladstone D, Sahlas D, Moody A. MR angiography of subclavian steal syndrome: pitfalls and solutions. AJR Am J Roentgenol. 2004;183:1840–1841.
Cosottini M, Zampa V, Petruzzi P, Ortori S, Cioni R, Bartolozzi C. Contrast-enhanced three-dimensional MR angiography in the assessment of subclavian artery diseases. Eur Radiol. 2000;10:1737–1744.
Patil S. Images in Medicine. Subclavian steal syndrome diagnosed by MR angiography. Med Health RI. 2001;84:173.
Sheehy N, MacNally S, Smith CS, Boyle G, Madhavan P, Meaney JF. Contrast-enhanced MR angiography of subclavian steal syndrome: value of the 2D time-of-flight “localizer” sign. AJR Am J Roentgenol. 2005;185:1069–1073.
Virmani R, Carroll TJ, Hung J, Hopkins J, Diniz L, Carr J. Diagnosis of subclavian steal syndrome using dynamic time-resolved magnetic resonance angiography: a technical note. Magn Reson Imaging. 2008;26:287–292.
Ringelstein EB, Zeumer H. Delayed reversal of vertebral artery blood flow following percutaneous transluminal angioplasty for subclavian steal syndrome. Neuroradiology. 1984;26:189–198.
Cohn LH, Fogarty TJ, Daily PO, Silverman JF, Shumway NE. Surgical treatment of atherosclerotic lesions of the subclavian artery. Calif Med. 1972;116:8–12.
Deriu GP, Milite D, Verlato F, et al. Surgical treatment of atherosclerotic lesions of subclavian artery: carotid-subclavian bypass versus subclavian-carotid transposition. J Cardiovasc Surg. 1998;39:729–734.
Gerety RL, Andrus CH, May AG, Rob CG, Green R, DeWeese JA. Surgical treatment of occlusive subclavian artery disease. Circulation. 1981;64:II228-II230.
Linni K, Ugurluoglu A, Mader N, Hitzl W, Magometschnigg H, Holzenbein TJ. Endovascular management versus surgery for proximal subclavian artery lesions. Ann Vasc Surg. 2008;22:769–775.
Bates MC, Broce M, Lavigne PS, Stone P. Subclavian artery stenting: factors influencing long-term outcome. Catheter Cardiovasc Interven. 2004;61:5–11.
Korner M, Baumgartner I, Do DD, Mahler F, Schroth G. PTA of the subclavian and innominate arteries: long-term results. Vasa. 1999;28:117–122.
Sullivan TM, Gray BH, Bacharach JM, et al. Angioplasty and primary stenting of the subclavian, innominate, and common carotid arteries in 83 patients. J Vasc Surg. 1998;28:1059–1065.
Patel SN, White CJ, Collins TJ, et al. Catheter-based treatment of the subclavian and innominate arteries. Catheter Cardiovasc Interven. 2008;71:963–968.
Sixt S, Rastan A, Schwarzwalder U, et al. Results after balloon angioplasty or stenting of atherosclerotic subclavian artery obstruction. Catheter Cardiovasc Interven. 2009;73:395–403.
Maclean AA, Pena CS, Katzen BT. Bivalirudin in peripheral interventions. Tech Vasc en Radiol. 2006;9:80–83.
Katzen BT, Ardid MI, MacLean AA, et al. Bivalirudin as an anticoagulation agent: safety and efficacy in peripheral interventions. J Vasc Interven Radiol. 2005;16:1183–1187; quiz 7.
Sheikh IR, Ahmed SH, Mori N, et al. Comparison of safety and efficacy of bivalirudin versus unfractionated heparin in percutaneous peripheral intervention: a single-center experience. JACC Cardiovasc Interven. 2009;2:871–876.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2012 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Yeo, K.K., Laird, J.R. (2012). Subclavian and Upper Extremity Interventions. In: Bhatt, D. (eds) Peripheral and Cerebrovascular Intervention. Contemporary Cardiology. Humana Press. https://doi.org/10.1007/978-1-60327-965-9_5
Download citation
DOI: https://doi.org/10.1007/978-1-60327-965-9_5
Published:
Publisher Name: Humana Press
Print ISBN: 978-1-60327-964-2
Online ISBN: 978-1-60327-965-9
eBook Packages: MedicineMedicine (R0)