Is there a conduit of preference for a bypass between the carotid and subclavian arteries?
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.
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Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242-1083.
Chalmers
R T
RT
Sharp
W J
WJ
Hoballah
J J
JJ
Kresowik
T F
TF
Corson
J D
JD
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