ABSTRACT
The burden of peripheral arterial disease will continue to increase as a consequence of aging population and increasing prevalence of diabetes. By the 1960s, atherosclerosis of the subclavian and brachiocephalic arteries was responsible for 17% of symptomatic extracranial cerebrovascular disease (1). In patients with symptoms of cerebrovascular ischemia, vertebral arteries had greater than 50% stenosis in 22%, and 18% of patients on the left and right side, respectively (2). Subclavian artery stenosis has been noted in 3.5% of all patients referred for coronary catheterization and in 41% of patients referred for coronary catheterization who had stigmata of peripheral arterial disease (3,4). Continual improvements in non-invasive diagnostic imaging modalities, such as magnetic resonance angiography and CTangiography allow rapid and accurate diagnosis of occlusive lesions in the subclavian and vertebral arteries (5). These developments, combined with technical innovations in endovascular therapy and growing awareness of peripheral arterial disease, will continue to foster a growth in the number of endovascular procedures. As the threshold for interventions in the subclavian, brachiocephalic and extracranial vertebral arteries becomes lower, the number of complications encountered will likely rise.
