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Occlusive Lesions of the Supra-Aortic Trunks in Nice

Dr. Ilya Khantalin, Vascular Surgeon in the Alpes-Maritimes

Occlusive Lesions of the Supra-Aortic Trunks

Dr. Ilya Khantalin in Nice

Occlusive lesions of the supra-aortic trunks are a group of serious vascular conditions affecting the main arteries located at the base of the neck that supply blood to the upper limbs, brain, and head. These lesions involve stenosis (narrowing) and occlusion (complete blockage) of the common carotid arteries, subclavian arteries, and vertebral arteries.

Arterial diseases are currently managed using modern techniques validated by the Haute Autorité de Santé, with a focus on innovation and strict adherence to recognized surgical protocols.

As a vascular surgery specialist, Dr. Ilya Khantalin welcomes patients in Saint-Laurent-du-Var for accurate diagnosis, therapeutic guidance, and tailored follow-up care for this condition.

Vascular diseases are recognized as Long-Term Illnesses (Affections de Longue Durée – ALD), allowing for 100% coverage by French Social Security.

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Understanding Occlusive Lesions of the Supra-Aortic Trunks

Vascular Surgeon in Saint-Laurent-du-Var

The arteries of the supra-aortic trunks include the subclavian and vertebral arteries, which supply blood to the arms, neck, and notably, to parts of the brain. An occlusive lesion in these arteries can result in serious symptoms and may pose a significant health risk.

Treatment of Occlusive Lesions of the Supra-Aortic Trunks

Vascular Surgery Specialist in Saint-Laurent-du-Var

Subclavian artery stenosis refers to a partial narrowing of the artery, which reduces blood flow to the upper limb and brain. This narrowing is typically due to atherosclerosis, the buildup of fatty and calcified deposits on the arterial walls. The left subclavian artery is most commonly affected, though the right side may also be involved.

Associated symptoms include:

  • Pain and weakness in the arm during movement or exertion (upper limb claudication)
  • Dizziness, especially when using both arms simultaneously (due to the “subclavian steal phenomenon”)
  • Occasionally, headaches, visual disturbances, and numbness

In some cases, stenosis progresses to complete occlusion of the subclavian artery, entirely blocking blood flow. This may lead to more severe symptoms than stenosis alone, including constant arm pain, reduced strength, and more pronounced neurological signs due to decreased cerebral perfusion.

The vertebral artery contributes to cerebral blood flow, particularly to the brain’s posterior regions via the basilar trunk. This artery can also be affected by stenosis or occlusion. Occlusion of the right or left vertebral artery may result in vertigo, balance disorders, and even transient ischemic attacks (TIAs) or strokes if blood flow is critically reduced.

Treatment depends on the lesion type and severity, as well as the patient’s overall health. Options include medical therapy, angioplasty, and surgical intervention.

Medical Treatment

Initial management of supra-aortic trunk stenosis usually involves addressing cardiovascular risk factors:

  • Antiplatelet therapy to reduce embolic risk
  • Lipid-lowering agents (statins) to lower cholesterol and slow atherosclerosis
  • Control of hypertension and diabetes to support arterial health

Medical treatment is generally sufficient for mild to moderate stenoses without severe symptoms. However, when symptoms become disabling or complications arise, intervention is warranted.

Angioplasty and Stent Placement

Angioplasty is a minimally invasive procedure that uses a balloon to widen the narrowed artery. A stent is often placed to keep the artery open. The procedure is performed under local anesthesia and usually requires only a short hospital stay.

Indications for angioplasty include:

  • Significant subclavian or vertebral artery stenosis with symptoms
  • Stenosis causing subclavian steal syndrome with neurological symptoms
  • Symptomatic occlusions of the subclavian or vertebral arteries

Bypass Surgery

For complete occlusions of the subclavian or vertebral artery, bypass surgery may be indicated. This involves creating a graft between two healthy arterial segments to bypass the blockage. The procedure is performed under general anesthesia.

Indications for bypass surgery include:

  • Complete subclavian artery occlusion with severe symptoms and/or vertebro-subclavian steal syndrome with vertebrobasilar insufficiency
  • Patients at risk of TIA or stroke due to vertebral artery occlusion

The choice of treatment depends on several factors:

  • Severity of the stenosis or occlusion
  • Presence of symptoms affecting quality of life
  • Risk of cerebral ischemia and the patient’s medical history

Prior to any procedure, a comprehensive assessment is performed:

  • Physical examination and detailed medical history
  • Imaging tests such as Doppler ultrasound, CT angiography (angio-CT), or MR angiography (angio-MRI) to evaluate the arterial status

Follow-up is essential for patients treated for occlusive lesions of the supra-aortic trunks to monitor treatment effectiveness and prevent recurrence. Follow-up includes:

  • Regular clinical exams to detect any recurrent symptoms
  • Imaging surveillance to ensure artery patency
  • Adjustment of medical therapy to manage cardiovascular risk factors

Postoperative patients should adopt a strict lifestyle: a balanced diet, regular physical activity, and smoking cessation. These measures, along with medical follow-up, help maintain long-term results and prevent complications.

Occlusive lesions of the supra-aortic trunks are serious vascular conditions requiring precise diagnosis and specialized care. Whether involving subclavian artery stenosis or vertebral artery occlusion, treatment options include medical therapy, angioplasty, or bypass surgery.

Dr. Ilya Khantalin, vascular surgeon in Saint-Laurent-du-Var, provides expert care throughout the diagnostic, treatment, and follow-up process.

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