Baylor University Medical Center Proceedings October 2017 - 433

Chicago, IL). The right axillary artery lesions were subsequently
predilated with a 4.0 mm × 40 mm Armada balloon (Abbott,
Chicago, IL), followed by drug-coated balloon angioplasty with
an IN.PACT Admiral 4.0 mm × 120 mm balloon (Medtronic,
Minneapolis, MN). Postintervention angiography revealed excellent luminal expansion without evidence of ﬂow-limiting
dissections (Figure 1b). Postprocedurally, the patient reported
resolution of her right upper-extremity symptoms, and the
blood pressure diﬀerential had resolved. At 6- and 12-month
follow-up, she remained asymptomatic, with 2+ right brachial,
radial, and ulnar pulses.

DISCUSSION
Given the rarity of atherosclerotic axillary artery disease,
most data on short- and long-term outcomes following percutaneous transluminal angioplasty (PTA) and/or stenting of
focal upper-extremity atherosclerotic disease are extrapolated
from subclavian artery revascularization (6) (Table 1). In a
retrospective study evaluating outcomes in 274 patients treated
with either a conservative (n = 165) or invasive (n = 109)
approach for subclavian artery atherosclerotic disease with a
median follow-up of 42 months, patients treated with PTA
had a 60% risk reduction for the development of a hemodynamically signiﬁcant stenosis (P < 0.01), deﬁned as an upperextremity blood pressure diﬀerential of ≥20 mm Hg compared
with conservative treatment (7).
Improvements in stent technology, coupled with widespread use, paved the way for studies evaluating the eﬃcacy of
stenting in upper-extremity vessels. An initial study by Sueoka
et al (8) evaluated the eﬃcacy of balloon-expandable stents in
treating proximal subclavian artery stenosis causing subclavian
steal syndrome after failure of an initial approach with PTA,
with a procedural success rate of 100%. Subsequent studies by
Rodriguez-Lopez et al (9) and Henry et al (10) demonstrated
good short- and mid-term patency rates, with similar longterm patency rates compared with PTA. A recently published
meta-analysis of 35 noncomparative studies with 1726 patients
examining PTA and stenting in subclavian arterial occlusive
disease found that technical success rates were higher in stented
patients, without a statistical diﬀerence in rates of symptom
resolution and long-term primary patency rates (6). We report
the ﬁrst case of symptomatic axillary artery disease successfully treated with oﬀ-label drug-coated balloon angioplasty and
resolution of symptoms postprocedurally.

1.
2.

Capers Q 4th, Phillips J. Advances in percutaneous therapy for upper
extremity arterial disease. Cardiol Clin 2011;29(3):351-361.
Shanmugasundaram M, Ram VK, Luft UC, Szerlip M, Alpert JS.
Peripheral arterial disease-what do we need to know? Clin Cardiol
2011;34(8):478-482.
Modarai B, Ali T, Dourado R, Reidy JF, Taylor PR, Burnand KG. Comparison of extra-anatomic bypass grafting with angioplasty for atherosclerotic
disease of the supra-aortic trunks. Br J Surg 2004;91(11):1453-1457.
Sixt S, Rastan A, Schwarzwälder U, Bürgelin K, Noory E, Schwarz T,
Beschorner U, Frank U, Müller C, Hauk M, Leppanen O, Hauswald K,
Brantner R, Nazary T, Neumann FJ, Zeller T. Results after balloon angioplasty or stenting of atherosclerotic subclavian artery obstruction. Catheter
Cardiovasc Interv 2009;73(3):395-403.

October 2017

10.

11.

12.

13.

14.
15.

16.
17.

18.

19.

20.

21.
22.

23.

24.

25.

26.

De Vries JP, Jager LC, Van den Berg JC, Overtoom TT, Ackerstaﬀ RG,
Van de Pavoordt ED, Moll FL. Durability of percutaneous transluminal
angioplasty for obstructive lesions of proximal subclavian artery: long-term
results. J Vasc Surg 2005;41(1):19-23.
Ahmed AT, Mohammed K, Chehab M, Brinjikji W, Murad MH, Cloft H,
Bjarnason H. Comparing percutaneous transluminal angioplasty and
stent placement for treatment of subclavian arterial occlusive disease:
a systematic review and meta-analysis. Cardiovasc Intervent Radiol
2016;39(5):652-667.
Schillinger M, Haumer M, Schillinger S, Mlekusch W, Ahmadi R, Minar E.
Outcome of conservative versus interventional treatment of subclavian artery
stenosis. J Endovasc Ther 2002;9(2):139-146.
Sueoka BL. Percutaneous transluminal stent placement to treat subclavian
steal syndrome. J Vasc Interv Radiol 1996;7(3):351-356.
Rodriguez-Lopez JA, Werner A, Martinez R, Torruella LJ, Ray LI,
Diethrich EB. Stenting for atherosclerotic occlusive disease of the
subclavian artery. Ann Vasc Surg 1999;13(3):254-260.
Henry M, Amor M, Henry I, Ethevenot G, Tzvetanov K, Chati Z.
Percutaneous transluminal angioplasty of the subclavian arteries. J Endovasc
Surg 1999;6(1):33-41.
Lowman BG, Queral LA, Holbrook WA, Estes JT, Bayly B, Dagher FJ.
The correction of cerebrovascular insuﬃciency by transluminal dilatation:
a preliminary report. Am Surg 1983;49(11):621-624.
Wilms G, Baert A, Dewaele D, Vermylen J, Nevelsteen A, Suy R.
Percutaneous transluminal angioplasty of the subclavian artery: early and
late results. Cardiovasc Intervent Radiol 1987;10(3):123-128.
Burke DR, Gordon RL, Mishkin JD, McLean GK, Meranze SG.
Percutaneous transluminal angioplasty of subclavian arteries. Radiology
1987;164(3):699-704.
Cook AM, Dyet JF. Six cases of subclavian stenosis treated by percutaneous
angioplasty. Clin Radiol 1989;40(4):352-354.
Jaschke W, Menges HW, Ockert D, Huck K, Georgi M. PTA of the
subclavian and innominate artery: short- and long-term results. Ann Radiol
(Paris) 1989;32(1):29-33.
Qi JP, Zeitler E. Catheter dilatation of arterial stenoses of supra-aortic
vessels and late results. Rofo 1991;155(4):357-362.
Hebrang A, Maskovic J, Tomac B. Percutaneous transluminal angioplasty
of the subclavian arteries: long-term results in 52 patients. AJR Am J
Roentgenol 1991;156(5):1091-1094.
Perrault LP, Carrier M, Hudon G, Lemarbre L, Hébert Y, Pelletier LC.
Transluminal angioplasty of the subclavian artery in patients with internal
mammary grafts. Ann Thorac Surg 1993;56(4):927-930.
Millaire A, Trinca M, Marache P, de Groote P, Jabinet JL, Ducloux G.
Subclavian angioplasty: immediate and late results in 50 patients. Cathet
Cardiovasc Diagn 1993;29(1):8-17.
Kumar K, Dorros G, Bates MC, Palmer L, Mathiak L, Dufek C. Primary
stent deployment in occlusive subclavian artery disease. Cathet Cardiovasc
Diagn 1995;34(4):281-285.
Motarjeme A. Percutaneous transluminal angioplasty of supra-aortic
vessels. J Endovasc Surg 1996;3(2):171-181.
Martinez R, Rodriguez-Lopez J, Torruella L, Ray L, Lopez-Galarza L,
Diethrich EB. Stenting for occlusion of the subclavian arteries. Technical
aspects and follow-up results. Tex Heart Inst J 1997;24(1):23-27.
Körner M, Baumgartner I, Do DD, Mahler F, Schroth G. PTA of the subclavian and innominate arteries: long-term results. Vasa 1999;28(2):117-
122.
Schillinger M, Haumer M, Schillinger S, Ahmadi R, Minar E. Risk
stratiﬁcation for subclavian artery angioplasty: is there an increased rate
of restenosis after stent implantation? J Endovasc Ther 2001;8(6):550-
557.
González A, Gil-Peralta A, González-Marcos JR, Mayol A. Angioplasty and
stenting for total symptomatic atherosclerotic occlusion of the subclavian
or innominate arteries. Cerebrovasc Dis 2002;13(2):107-113.
Angle JF, Matsumoto AH, McGraw JK, Spinosa DJ, Hagspiel KD, Leung
DA, Tribble CG. Percutaneous angioplasty and stenting of left subclavian
artery stenosis in patients with left internal mammary-coronary bypass

Endovascular therapy of axillary artery disease with drug-coated balloon angioplasty

433

Table of Contents for the Digital Edition of Baylor University Medical Center Proceedings October 2017