Comparative results of carotid-subclavian bypass and axillo-axillary bypass in patients with symptomatic subclavian disease.
The results of 26 carotid-subclavian bypass (CSB) and 17 axillo-axillary bypass (AAB) procedures, performed to treat symptomatic lesions of the proximal subclavian artery, were reviewed. Nine graft failures (seven CSB and two AAB) occurred (mean follow-up: CSB = 60.5 +/- 41 months; AAB = 67.8 +/- 48 months). All CSB graft thromboses were observed in patients with an associated ipsilateral carotid lesion, surgically treated or not (p less than 0.05). Cumulative 5- and 10-year patency rates were 78.3 and 62.9% for the CSB group and 87.9% for the AAB group (N.S.). In patients with an associated ipsilateral carotid lesion, 5- and 10-year patency rates were 66.0% and 40.8% for the CSB group and 100% for the AAB group (p less than 0.05). Both the surgical procedures were safe and effective with excellent results in terms of operative mortality, major morbidity and long-term patency. CSB is the procedure of choice for the treatment of proximal subclavian artery disease for its physiological characteristics and for graft shortness. However AAB must be considered a suitable alternative and preferred when a concomitant ipsilateral carotid lesion is present. Recurrence of carotid stenosis or carotid lesion progression may cause the carotid-subclavian failure.
Mingoli
A
A
First Department of Surgery, La Sapienza University, Rome, Italy.
Feldhaus
R J
RJ
Farina
C
C
Schultz
R D
RD
Cavallaro
A
A
D000368:Aged; D001366:Axillary Artery / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D002545:Brain Ischemia / Q000601:surgery*; D002339:Carotid Arteries / Q000601:surgery*; D016893:Carotid Stenosis / Q000601:surgery; D004691:Endarterectomy; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D013349:Subclavian Steal Syndrome / Q000601:surgery*; D014715:Vertebrobasilar Insufficiency / Q000601:surgery