title: Is there a conduit of preference for a bypass between the carotid and subclavian arteries?
abstract: The conduit of choice for a bypass between the carotid and subclavian arteries remains controversial. We retrospectively evaluated 32 patients who underwent bypass between the carotid and subclavian arteries. Perioperative mortality was limited to a single patient who sustained a myocardial infarction. Long-term follow-up (mean: 46 months) revealed an 87% stroke-free survival rate, a 74% neurologic symptom-free survival rate, and a 77% primary patency rate at 5 years. No overall difference was discerned between a prosthetic or autogenous vein conduit. However, in bypasses constructed from the subclavian artery to the level of the carotid bifurcation, 100% (nine of nine) of vein bypasses remained primarily patent compared with 40% (two of five) of prosthetic grafts (p < 0.05). No distinct patency difference was identified between a short vein or a prosthetic bypass constructed between the proximal common carotid artery and subclavian artery. A vein bypass results in superior patency compared with a prosthetic graft for longer bypasses constructed from the subclavian artery to the carotid artery bifurcation.
authors.affiliation: Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242-1083.
authors.forename: A Y
authors.initials: AY
authors.lastname: Synn
authors.forename: R T
authors.initials: RT
authors.lastname: Chalmers
authors.forename: W J
authors.initials: WJ
authors.lastname: Sharp
authors.forename: J J
authors.initials: JJ
authors.lastname: Hoballah
authors.forename: T F
authors.initials: TF
authors.lastname: Kresowik
authors.forename: J D
authors.initials: JD
authors.lastname: Corson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001807:Blood Vessel Prosthesis / Q000401:mortality; D017536:Carotid Artery, Common / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D013348:Subclavian Artery / Q000601:surgery*; D015996:Survival Rate; D014654:Vascular Patency; D014680:Veins / Q000637:transplantation