Screening for Subclavian Artery Stenosis

Abstract

Introduction: Subclavian artery stenosis of >50% has been linked to an increased risk of cardiovascular morbidity, complications after carotid interventions, and difficulty in managing hypertension. This has led to increased emphasis on screening for these lesions. In addition, these lesions may be associated with upper extremity symptoms including claudication and pain at rest. Methods: A retrospective review of patients who were referred over a 2-year period for arm pain in the setting of suspected or proven subclavian artery stenosis or occlusion was performed. This was compared to an unmatched cohort of patients who underwent carotid artery duplex with subclavian artery duplex for other reasons. Data included measuring the interbrachial systolic pressure difference (>15 and >20 mm Hg), arm-arm index, and hand acceleration time (HAT). Results: Among the172 patients studied, 48 had subclavian artery stenosis or occlusion and 26 of these had corresponding symptoms. Female gender ( P = .012), history of coronary intervention ( P = .007), hypertension ( P = .039), and arm-arm index of <0.9 ( P = .0001) were significantly associated with subclavian artery stenosis or occlusion. A HAT of >100 milliseconds was significantly associated with symptomatic subclavian artery stenosis or occlusion. Conclusions: An arm-arm index of <0.9 is a useful tool for screening for subclavian artery stenosis. In patients with subclavian artery stenosis, HAT may be useful in confirming that the arm symptoms are due to this particular lesion.