title: Treatment of subclavian artery stenosis: A case series.
abstract: BACKGROUND
  In this case series, different modalities of treatment for patients with ischaemic symptoms of subclavian stenosis are described, including the different operative strategies that can be adopted in more challenging cases. This is the first case series describing these four management options.
  
  
  METHODS
  Case 1: A seventy-one year-old female presented with acute on chronic ischaemia of her left arm following a fall and developed dry gangrene of her left thumb. This was initially managed with a heparin infusion followed by stenting of the subclavian artery which relieved her symptoms. Case 2: A fifty-nine year-old male presented with chronic ischemia of the left arm secondary to an occlusion of the left subclavian artery. This was managed by transposition of the left subclavian artery onto the left common carotid artery. Case 3: A sixty-four year-old female presented with left subclavian steal syndrome secondary to subclavian artery stenosis. She underwent carotid subclavian artery bypass. Case 4: A fifty-six year-old female presented with acute left upper limb ischaemia secondary to acutely thrombosed subclavian artery on a CT-angiography. She underwent a carotid to axillary bypass.
  
  
  CONCLUSIONS
  This case series demonstrates the treatment options available to vascular surgeons when managing symptomatic subclavian artery disease. Symptomatic subclavian artery occlusive disease should be treated with endovascular stenting and angioplasty as first line management. If it is not successful then open surgery should be considered. Bypassing the carotid to the subclavian or to the axillary artery are both good treatment modalities.
authors.affiliation: Queen Elizabeth Hospital, Queen Elizabeth Avenue, Gateshead NE9 6SX, UK. Electronic address: reem.salman@ghnt.nhs.uk.
authors.forename: Reem
authors.initials: R
authors.lastname: Salman
authors.affiliation: Queen Elizabeth Hospital, Queen Elizabeth Avenue, Gateshead NE9 6SX, UK. Electronic address: j.hornsby@doctors.org.uk.
authors.forename: Jane
authors.initials: J
authors.lastname: Hornsby
authors.affiliation: Queen Elizabeth Hospital, Queen Elizabeth Avenue, Gateshead NE9 6SX, UK. Electronic address: luciejwright@doctors.org.uk.
authors.forename: Lucie J
authors.initials: LJ
authors.lastname: Wright
authors.affiliation: Queen Elizabeth Hospital, Queen Elizabeth Avenue, Gateshead NE9 6SX, UK. Electronic address: tarek.elsaid@ghnt.nhs.uk.
authors.forename: Tarek
authors.initials: T
authors.lastname: Elsaid
authors.affiliation: Queen Elizabeth Hospital, Queen Elizabeth Avenue, Gateshead NE9 6SX, UK. Electronic address: grace.timmons@ghnt.nhs.uk.
authors.forename: Grace
authors.initials: G
authors.lastname: Timmons
authors.affiliation: Queen Elizabeth Hospital, Queen Elizabeth Avenue, Gateshead NE9 6SX, UK. Electronic address: ahmed.mudawi@ghnt.nhs.uk.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Mudawi
authors.affiliation: Queen Elizabeth Hospital, Queen Elizabeth Avenue, Gateshead NE9 6SX, UK. Electronic address: vish.bhattacharya@ghnt.nhs.uk.
authors.forename: Vish
authors.initials: V
authors.lastname: Bhattacharya
keywords: Subclavian artery stenosis; Subclavian steal syndrome