Subclavian Artery Intervention Hartaj S Virk MD Heart

Subclavian Artery Intervention Hartaj S. Virk, MD Heart and Vascular Associates, Paterson, NJ

Hartaj S. Virk, MD I/we have no real or apparent conflicts of interest to report.

Indications for Subclavian Revascularisation • Exercise Induced Ischemia-Upper Extremity. • Embolization- Digital/Cerebral. • Steal Syndrome – Vertebral or Coronary. • To Protect Axillo-Fem Bypass or AV fistulae.

Technique • Access • Non-Selective Angiography • Guide or Sheath • PTA/Stent RAO Caudal The information in this document is protected by the privilege of self-analysis and the Peer Review Improvement Act of 1982 42 U. S. C. § 1320 c-3 et seq. , The Health Care Quality Improvement Act 42 U. S. C. § 11101, et seq. , N. J. S. A. 2 A: 84 A-22. 8 and Hospital Policy. This document and the information contained herein, is strictly confidential, and may not be disclosed or distributed to any person or entity outside of the peer review or utilization review process, except as otherwise provided by law

Access- Femoral, Brachial/Radial • • Ease of Crossing the Lesion. Risk of Complications 3 -4 X with Brachial. Sheath size to deliver the Balloons and Stents. Sheath size to deliver Covered stents in case of Perforations.

Technical Considerations • Location-Ostial, Proximal or Distal. • Plaque morphology and presence of any Thrombus. • Size Differential Between Proximal and Distal Vessel. • Adequate Landing Zone to Avoid compromising the Vertebral/IMA. The information in this document is protected by the privilege of self-analysis and the Peer Review Improvement Act of 1982 42 U. S. C. § 1320 c-3 et seq. , The Health Care Quality Improvement Act 42 U. S. C. § 11101, et seq. , N. J. S. A. 2 A: 84 A-22. 8 and Hospital Policy. This document and the information contained herein, is strictly confidential, and may not be disclosed or distributed to any person or entity outside of the peer review or utilization review process, except as otherwise provided by law

Steps of Subclavian Intervention The information in this document is protected by the privilege of self-analysis and the Peer Review Improvement Act of 1982 42 U. S. C. § 1320 c-3 et seq. , The Health Care Quality Improvement Act 42 U. S. C. § 11101, et seq. , N. J. S. A. 2 A: 84 A-22. 8 and Hospital Policy. This document and the information contained herein, is strictly confidential, and may not be disclosed or distributed to any person or entity outside of the peer review or utilization review process, except as otherwise provided by law

Non Selective/Selective Angiography-LAO The information in this document is protected by the privilege of self-analysis and the Peer Review Improvement Act of 1982 42 U. S. C. § 1320 c-3 et seq. , The Health Care Quality Improvement Act 42 U. S. C. § 11101, et seq. , N. J. S. A. 2 A: 84 A-22. 8 and Hospital Policy. This document and the information contained herein, is strictly confidential, and may not be disclosed or distributed to any person or entity outside of the peer review or utilization review process, except as otherwise provided by law

Characterization of the Lesion & defining the origin of Distal Vessel The information in this document is protected by the privilege of self-analysis and the Peer Review Improvement Act of 1982 42 U. S. C. § 1320 c-3 et seq. , The Health Care Quality Improvement Act 42 U. S. C. § 11101, et seq. , N. J. S. A. 2 A: 84 A-22. 8 and Hospital Policy. This document and the information contained herein, is strictly confidential, and may not be disclosed or distributed to any person or entity outside of the peer review or utilization review process, except as otherwise provided by law

PTA/Stent The information in this document is protected by the privilege of self-analysis and the Peer Review Improvement Act of 1982 42 U. S. C. § 1320 c-3 et seq. , The Health Care Quality Improvement Act 42 U. S. C. § 11101, et seq. , N. J. S. A. 2 A: 84 A-22. 8 and Hospital Policy. This document and the information contained herein, is strictly confidential, and may not be disclosed or distributed to any person or entity outside of the peer review or utilization review process, except as otherwise provided by law

Final Angiogram The information in this document is protected by the privilege of self-analysis and the Peer Review Improvement Act of 1982 42 U. S. C. § 1320 c-3 et seq. , The Health Care Quality Improvement Act 42 U. S. C. § 11101, et seq. , N. J. S. A. 2 A: 84 A-22. 8 and Hospital Policy. This document and the information contained herein, is strictly confidential, and may not be disclosed or distributed to any person or entity outside of the peer review or utilization review process, except as otherwise provided by law

Difficult Lesion to Cross The information in this document is protected by the privilege of self-analysis and the Peer Review Improvement Act of 1982 42 U. S. C. § 1320 c-3 et seq. , The Health Care Quality Improvement Act 42 U. S. C. § 11101, et seq. , N. J. S. A. 2 A: 84 A-22. 8 and Hospital Policy. This document and the information contained herein, is strictly confidential, and may not be disclosed or distributed to any person or entity outside of the peer review or utilization review process, except as otherwise provided by law

Distal Subclavian Intervention The information in this document is protected by the privilege of self-analysis and the Peer Review Improvement Act of 1982 42 U. S. C. § 1320 c-3 et seq. , The Health Care Quality Improvement Act 42 U. S. C. § 11101, et seq. , N. J. S. A. 2 A: 84 A-22. 8 and Hospital Policy. This document and the information contained herein, is strictly confidential, and may not be disclosed or distributed to any person or entity outside of the peer review or utilization review process, except as otherwise provided by law

Chronic Total Occlusion of the Left Subclavian Artery The information in this document is protected by the privilege of self-analysis and the Peer Review Improvement Act of 1982 42 U. S. C. § 1320 c-3 et seq. , The Health Care Quality Improvement Act 42 U. S. C. § 11101, et seq. , N. J. S. A. 2 A: 84 A-22. 8 and Hospital Policy. This document and the information contained herein, is strictly confidential, and may not be disclosed or distributed to any person or entity outside of the peer review or utilization review process, except as otherwise provided by law

Crossing/Snaring/Stent The information in this document is protected by the privilege of self-analysis and the Peer Review Improvement Act of 1982 42 U. S. C. § 1320 c-3 et seq. , The Health Care Quality Improvement Act 42 U. S. C. § 11101, et seq. , N. J. S. A. 2 A: 84 A-22. 8 and Hospital Policy. This document and the information contained herein, is strictly confidential, and may not be disclosed or distributed to any person or entity outside of the peer review or utilization review process, except as otherwise provided by law

Chronic Total Occlusion Right Subclavian Artery The information in this document is protected by the privilege of self-analysis and the Peer Review Improvement Act of 1982 42 U. S. C. § 1320 c-3 et seq. , The Health Care Quality Improvement Act 42 U. S. C. § 11101, et seq. , N. J. S. A. 2 A: 84 A-22. 8 and Hospital Policy. This document and the information contained herein, is strictly confidential, and may not be disclosed or distributed to any person or entity outside of the peer review or utilization review process, except as otherwise provided by law

Crossing/PTA/Stent The information in this document is protected by the privilege of self-analysis and the Peer Review Improvement Act of 1982 42 U. S. C. § 1320 c-3 et seq. , The Health Care Quality Improvement Act 42 U. S. C. § 11101, et seq. , N. J. S. A. 2 A: 84 A-22. 8 and Hospital Policy. This document and the information contained herein, is strictly confidential, and may not be disclosed or distributed to any person or entity outside of the peer review or utilization review process, except as otherwise provided by law

Restenosis/Complications The information in this document is protected by the privilege of self-analysis and the Peer Review Improvement Act of 1982 42 U. S. C. § 1320 c-3 et seq. , The Health Care Quality Improvement Act 42 U. S. C. § 11101, et seq. , N. J. S. A. 2 A: 84 A-22. 8 and Hospital Policy. This document and the information contained herein, is strictly confidential, and may not be disclosed or distributed to any person or entity outside of the peer review or utilization review process, except as otherwise provided by law

Technical Considerations: Lesions to Avoid/Caution • Presence of Fresh Thrombus. • Lesions which involve the Vertebral or Common Carotid Artery. • ? Lesions adjacent to an Aneurysm. The information in this document is protected by the privilege of self-analysis and the Peer Review Improvement Act of 1982 42 U. S. C. § 1320 c-3 et seq. , The Health Care Quality Improvement Act 42 U. S. C. § 11101, et seq. , N. J. S. A. 2 A: 84 A-22. 8 and Hospital Policy. This document and the information contained herein, is strictly confidential, and may not be disclosed or distributed to any person or entity outside of the peer review or utilization review process, except as otherwise provided by law

Conclusion • Indications of Subclavian Artery Intervention. • Steps of Intervention. • Access- Femoral/Brachial/Radial. • Critical Views- LAO/RAO. • Stents- Balloon/Self Expandable. The information in this document is protected by the privilege of self-analysis and the Peer Review Improvement Act of 1982 42 U. S. C. § 1320 c-3 et seq. , The Health Care Quality Improvement Act 42 U. S. C. § 11101, et seq. , N. J. S. A. 2 A: 84 A-22. 8 and Hospital Policy. This document and the information contained herein, is strictly confidential, and may not be disclosed or distributed to any person or entity outside of the peer review or utilization review process, except as otherwise provided by law

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