Treatment Strategies for Subclavian Artery Occlusion: A Comparative Analysis of Endovascular Repair, Subclavian-Carotid Bypass, and Transposition

作者：Ke Zhang, Yuanrui Gu, Haorui Zhang, Yanxia Tu, Cuntao Yu, Chenxi Ouyang · 发表于：Journal of Endovascular Therapy · 年份：2025 · DOI：10.1177/15266028251353408 · 被引用次数：1 · 研究领域：Cerebrovascular and Carotid Artery Diseases、Peripheral Artery Disease Management、Reconstructive Surgery and Microvascular Techniques

BACKGROUND: We aimed to compare the technical success rates and long-term patency of endovascular repair, subclavian-carotid bypass (SCB), and subclavian-carotid transposition (SCT) for subclavian artery occlusion. METHODS: A retrospective analysis was conducted on 181 patients at Fuwai Hospital (2015-2024). Primary endpoint was the primary patency rate. Secondary endpoints included technical success, secondary patency and freedom from target lesion revascularization (TLR) rates. Kaplan-Meier analyses were applied. RESULTS: One hundred and eighty-one patients [median age: 60 years, interquartile range (IQR) 54.00-65.00; 76.2% male) underwent 192 procedures, with 111 endovascular repairs, 38 SCBs, and 43 SCTs. Indications included vertebrobasilar insufficiency (39.2%), arm ischemia (28.7%), both (29.3%), cardiac causes (2.2%), and combined arm and cardiac indications (0.6%). The endovascular group had a lower technical success rate than SCB and SCT (86.5% vs 97.4% vs 100.0%). SCT had the longest lesion-to-vertebral artery (VA) length among the 3 groups. Ostial occlusion was more frequent and lesion length was longer in failed cases compared to successful cases (33.3% vs 6.3%, 14.50 vs 22.00 mm). After a median follow-up of 44 months (IQR 22.00-70.00), SCT had the highest primary patency rate (100% at 1, 3, and 5 years) compared to endovascular repair (93.4%, 88.2%, 77.6%) and SCB (94.1%, 86.8%, 72.3%; p=0.12). Endovascular group had primary patency, secondary patency, and free...