A combined approach to the treatment of proximal arterial occlusions of the upper limb with endovascular stents

Background:The traditional transfemoral approach to endovascular stenting is not ideal for proximal arterial lesions of the upper limb. The distance of the lesion from the femoral puncture site, flexibility and unsupported length of guidewires/delivery systems and often acutely angled origins of the great vessels combine to make crossing the lesions and accurate deployment of the device difficult or impossible. Deployment of the stent via a brachial arteriotomy should obviate these problems.Aim:The authors report a series of patients with proximal arterial occlusions of the upper limb treated by endoluminal stenting using a combined surgical/radiological approach.Patients and methods:Using the combined approach we have attempted to treat 18 proximal upper limb occlusions (eight brachiocephalic origin, six subclavian origin, two subclavian artery and two axillary artery). Where possible, occlusions were treated by primary stent deployment. All patients received perioperative IV heparin followed by long-term aspirin.Results:Revascularisation was successful in 15 of 18 proximal occlusions with complete resolution of symptoms. All stented vessels remain patent up to 36 months after the procedure and there have been no complications arising from the brachial arteriotomy sites.Conclusions:Primary stenting is the treatment of choice for proximal occlusions of the upper limb vessels. A combined surgical/radiological approach via a brachial arteriotomy can be used in these cases and is now the method of choice for the treatment of such lesions in this unit