Baylor University Medical Center Proceedings October 2017 - 431

Endovascular therapy of axillary artery disease with
drug-coated balloon angioplasty
Subhi J. Al'Aref, MD, Rajesh V. Swaminathan, MD, and Dmitriy N. Feldman, MD

The occurrence of upper-extremity arterial disease is less common than
that of the lower extremities. Nevertheless, exercise-induced symptoms,
when present, can significantly affect functional capacity and limit quality of life. We report a case of exertional right upper-extremity pain and
severe right axillary artery disease that was revascularized using an
off-label drug-coated balloon technology with resolution of symptoms.

linical manifestations of upper-extremity arterial disease tend to be distinct from those of lower-extremity
disease, given the abundance of collateral circulation
(1, 2). The main focus in managing upper-extremity
arterial disease is treatment of preexisting cardiovascular risk
factors with aggressive medical therapy and lifestyle modiﬁcation. When refractory symptoms ensue, surgical or percutaneous
revascularization should be considered. Surgery with bypass
grafts has been associated with improved patency compared to
endovascular therapy, but with comparable complication rates
(3). When endovascular therapy is considered, the preferred
method remains controversial (4, 5). We present a patient with
symptoms of right upper-extremity claudication and likely obstructive atherosclerotic disease of the axillary artery who underwent successful revascularization using drug-coated balloon
angioplasty with subsequent resolution of symptoms.
CASE REPORT
A 66-year-old woman presented with right arm claudication. She had a prior history of hypertension, hyperlipidemia,
pulmonary sarcoidosis, rheumatic heart disease, atrial ﬁbrillation, and a permanent pacemaker for tachy-brady syndrome.
She had extensive atherosclerotic disease with known nonobstructive coronary and carotid artery disease and previous percutaneous revascularization for peripheral arterial disease. The
patient had been maintained on aspirin and clopidogrel.
She presented with progressive symptoms of right arm discomfort, aggravated by exercise and heavy-object lifting. Examination disclosed a 40 mm Hg systolic blood pressure diﬀerential
between the upper extremities and a diminished right radial
pulse. Ultrasound of the upper extremities demonstrated severe
right and moderate left axillary artery disease. Computed tomographic (CT) angiography conﬁrmed the ultrasound ﬁndings

Proc (Bayl Univ Med Cent) 2017;30(4):431-434

Figure 1. Digital subtraction angiography images (a) before intervention, showing
diffuse, obstructive atherosclerotic disease in the right axillary artery, and (b) after
treatment with drug-coated balloon angioplasty.
From Dalio Institute of Cardiovascular Imaging, New York Presbyterian Hospital,
New York, New York (Al'Aref); Duke University Medical Center and the Duke Clinical
Research Institute, Durham, North Carolina (Swaminathan); and Division of Cardiology,
Department of Medicine, Weill Cornell Medicine, New York, New York (Feldman).
Corresponding author: Subhi J. Al'Aref, MD, Dalio Institute of Cardiovascular
Imaging, New York Presbyterian Hospital, Weill Cornell Medicine, 413 East 69th
Street, New York, NY 10021 (e-mail: sua9028@med.cornell.edu).
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Table of Contents for the Digital Edition of Baylor University Medical Center Proceedings October 2017