ABSTRACT
What Makes a Lesion “Complex” in Subclavian Interventions? While most interventional procedures in the subclavian region are fairly straightforward, there are conditions that increase the complexity of intervention. Flush occlusions of the subclavian artery, usually occurring on the left side, can make passage of a wire difficult, particularly from the retrograde femoral approach. The retrograde brachial approach is more satisfactory in this setting, since a wire and guiding catheter can be placed to assist in penetration of the plaque. Nonetheless, the wire may still deviate, producing a dissection or procedural failure. The relationship of the vessel orifice and the occlusion or stenosis can create the potential for vertebral artery compromise. Aortic arch configurations are variable and, in some cases, it can be difficult to manipulate the wire and catheter. Any or all of these types of complications (as well as others) can add to the complexity of subclavian intervention.
