title: Dealing with symptomatic stenosis of the subclavian artery: Open or endovascular approach? A case report.
abstract: BACKGROUND
  Stenosis of the subclavian artery is uncommon and it rarely causes symptoms. Only symptomatic patients should be treated.
  
  
  METHODS
  We report a case of chronic left upper limb ischemia caused by subclavian artery stenosis after repetitive clavicular fixation. The stenosis was first treated with carotid-subclavian bypass and soon followed by angioplasty and stenting of the subclavian artery because of occlusion of the bypass. Finally, failure of these procedures necessitated a subclavian-axillary crossover bypass.
  
  
  CONCLUSIONS
  Both extra-anatomic bypass and percutaneous transluminal angioplasty are safe and effective. If feasible, many authors use endovascular treatment. According to literature, extra-anatomic bypass still remains the first choice of treatment for symptomatic patients. However, the introduction of routine stent implantation is equalling these results. Because of its lower long-term patency rate, endovascular treatment is favorable for patients at high risk.
  
  
  CONCLUSIONS
  Our case is a good example of difficulties involved in choosing the best treatment option for subclavian artery stenosis.
authors: Department of Vascular Surgery, AZ Damiaan, Ostend, Belgium. Electronic address: hozan.mufty@hotmail.com.
authors: Hozan
authors: H
authors: Mufty
authors: Surgery Department, AZ Damiaan, Ostend, Belgium.
authors: Alfred
authors: A
authors: Janssen
authors: Department of Vascular Surgery, AZ Damiaan, Ostend, Belgium.
authors: Stijn
authors: S
authors: Schepers
keywords: Cross over bypass; Subclavian artery stenosis; Subclavian bypass