title: Arterial reconstruction for subclavian obstructive disease: a comparison of extrathoracic procedures.
abstract: OBJECTIVE
  Comparison of the immediate and long-term results of three different extrathoracic arterial reconstruction procedures for subclavian obstructive disease.
  
  
  METHODS
  Retrospective analysis of 51 extrathoracic subclavian artery reconstructions in 49 patients performed in a single centre over an 18-year period (mean follow-up 64 months, range 3-192).
  
  
  METHODS
  Carotid-subclavian bypass (CSB, n = 21), subclavian-carotid transposition (SCT, n = 21) and subclavian-subclavian or axillo-axillary cross-over bypass (COB, n = 9) was performed. Upper extremity ischaemic complaints were present in 45/49 patients (92%) and vertebrobasilar insufficiency in 25/49 patients (51%). Symptom relief, improvement of haemodynamic parameters and graft patency were compared.
  
  
  RESULTS
  Operation time was significantly shorter (p < 0.001, t-test) in SCT (80 +/- 5 min) compared to CSB (112 +/- 7 min) and COB (116 +/- 6 min). Symptom relief and improvement of haemodynamic parameters were similar for all groups. There were no differences in morbidity rate and there was no mortality. The cumulative patency of SCT was significantly better with 100% at 2, 5 and 10 years postoperatively compared to CSB (75.6%, 62.6% and 52.2%, respectively) (p < 0.005, log-rank test) and COB (76.5%, 63.7% and 63.7%, respectively) (p < 0.02, log-rank test). There was a tendency for a better patency in prosthetic grafts as compared to autologous vein grafts in CSB (NS, log-rank test).
  
  
  CONCLUSIONS
  Satisfactory immediate and long-term results were obtained with all of the above techniques. When technically feasible, SCT is the procedure of choice for extrathoracic arterial reconstruction in subclavian obstructive disease.
authors.affiliation: Department of Surgery, St. Radboud University Hospital, Nijmegen, The Netherlands.
authors.forename: J A
authors.initials: JA
authors.lastname: van der Vliet
authors.forename: H W
authors.initials: HW
authors.lastname: Palamba
authors.forename: D M
authors.initials: DM
authors.lastname: Scharn
authors.forename: S F
authors.initials: SF
authors.lastname: van Roye
authors.forename: F G
authors.initials: FG
authors.lastname: Buskens
mesh_terms: D001132:Arm / Q000098:blood supply*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007511:Ischemia / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008722:Methods; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013348:Subclavian Artery / Q000601:surgery*; D014654:Vascular Patency; D014715:Vertebrobasilar Insufficiency / Q000503:physiopathology / Q000601:surgery*