Clinical Analysis On Endovascular Management Of In Subclavian Steal Syndrome

Objective:To evaluate the efficacy and safety of the endovascularmanagement(PTA、Stenting) for subclavian steal syndrome.Methods:20patients with SSS,aged between27to71years.One of thesepatients with both sides of subclavian arteries stenosis.So,there are21subclavian arteries with stenosis or occlusive lesion.Which the leftsubclavian artery stenosis in18cases,the right subclavian arterystenosis in3cases.All of the patients have some level of vertebrobasilarinsufficiency.21cases were tried by the femoral artery puncture,orcombined with brachial artery catheterization.Then if the guide wirepassed the lesion,PTA combined with stenting were implemented.Surgicaltreatment will be recommended if the guide wire can’t pass through thenarrow vessel.To observe patency of endovascular therapy, blood pressuredifference of contralateral and ipsilateral,color doppler of vertebralartery and subclavian artery were adopted.Results:DSA showed subclavian artery with total occlusive in12cases(57.1%).All subclavian artery stenosis in70%-100%,mean90.95%.16cases(76.2%) guide wire get through the stricture in patients,thensuccessfully underwent stent implantation after balloon dilation.5caseshave been punctured in femoral artery and brachial artery,but the guidewire can’t pass through the narrow lesion yet,then decided change to thesurgical treatment.3patients gave up further treatment,2underwentcarotid-subclavian artery autogenous saphenous vein bypass.all weresuccessful.The16cases succeed in endovascular management,the degree ofstenosis70%to100%,mean88.13%,stricture length was9-32mm,mean21.94mm.After endovascular management,the residual stenosis were range from0%to10%，mean2.375%.Systolic blood pressure difference from20-65mmHg,mean36.69mmHg before the operative.Postoperative7.62mmHg.Therewere no obvious complications postoperative.Patients were followed up4to44months,Restenosis occur in1case which underwent endovasculartreatment.All of The rest patients occur no restonsis, no recurrence ofneurological symptoms and upper limb ischemia symptoms.Conclusion:Endovascular treatment for SSS have a higher success rate,andhas a better short/mid-term patency.Compared with bypass surgery,endovascular treatment has smaller risks;less complications;lessinvasion;shorter hospitalization period.When there is indication ofboth,we choose endovascular management as the first-line treatment.Longterm patency rate needs further observation.