A COMBINED APPROACH TO THE TREATMENT OF PROXIMAL ARTERIAL OCCLUSIONS OF THE UPPER-LIMB WITH ENDOVASCULAR STENTS

Background: The traditional transfemoral approach to endovascular sten ting is not ideal for proximal arterial lesions of the upper limb. The distance of the lesion from the femoral puncture site, flexibility an d unsupported length of guide-wires/delivery systems and often acutely angled origins of the great vessels combine to make crossing the lesi ons and accurate deployment of the device difficult or impossible. Dep loyment of the stent via a brachial arteriotomy should obviate these p roblems. Aim: The authors report a series of patients with proximal ar terial occlusions of the upper limb treated by endoluminal stenting us ing a combined surgical/radiological approach. Patients and methods: U sing the combined approach we have attempted to treat 18 proximal uppe r limb occlusions (eight brachiocephalic origin, six subclavian origin , two subclavian artery and two axillary artery). Where possible, occl usions were treated by primary stent deployment. All patients received perioperative IV heparin followed by long-term aspirin. Results: Reva scularisation was successful in 15 of 18 proximal occlusions with comp lete resolution of symptoms. All stented vessels remain patent lip to 36 months after the procedure and there have been no complications ari sing from rite brachial arteriotomy sites. Conclusions: Primary stenti ng is the treatment of choice for proximal occlusions of the upper lim b vessels. A combined surgical/radiological approach via a brachial ar teriotomy can be used in these eases and is now the method of choice f or the treatment of such lesions in this unit.