title: Subclavian artery revascularization: a decade of experience with extrathoracic bypass procedures.
abstract: Extrathoracic revascularization has become the most popular form of surgical correction of symptomatic subclavian artery lesions. During a 10-year period ending in December 1991, 41 extrathoracic bypass procedures were performed on 37 patients for proximal subclavian artery stenosis or occlusion. This included 25 females and 12 males, with a mean age of 56 years. Surgery was performed for manifestations of upper extremity ischemia in 19 patients (51%), vertebrobasilar insufficiency in four patients (11%), and both upper extremity ischemia and vertebrobasilar insufficiency in 11 patients (30%). Three patients (8%) had angina pectoris caused by "coronary-subclavian steal" following internal mammary-coronary artery bypass. Severe proximal stenosis or complete occlusion of the subclavian artery was demonstrated angiographically in all cases. Procedures performed included: carotid-subclavian bypass (n = 28), subclavian-carotid transposition (n = 6), axilloaxillary bypass (n = 4), and subclavian-subclavian bypass (n = 3). Saphenous vein was used as the bypass conduit in 6 of the carotid-subclavian bypass procedures, and prosthetic grafts were used for the remainder. There were no perioperative strokes or deaths in this series, and the mean postoperative hospital stay was 4 days. Follow-up ranged from 2 to 96 months (mean, 35.6 months). The overall patency rate was 95% at 1 year, 86% at 3 years, and 73% at 5 years. Patency at 5 years was significantly higher for procedures utilizing the common carotid artery as the donor vessel as compared with those using the contralateral subclavian or axillary arteries (83% versus 46%, P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Section of General Vascular Surgery, Emory University, Atlanta, Georgia 30322.
authors.forename: T A
authors.initials: TA
authors.lastname: Salam
authors.forename: A B
authors.initials: AB
authors.lastname: Lumsden
authors.forename: R B
authors.initials: RB
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D001161:Arteriosclerosis / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013348:Subclavian Artery / Q000601:surgery*; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome