Long-term results with axillo-axillary bypass grafts for symptomatic subclavian artery insufficiency.
OBJECTIVE
The surgical treatment for patients with a subclavian steal is controversial, especially for patients with coexisting severe carotid stenosis. This study determines the long-term efficacy of axillo-axillary bypass grafts in patients with and without a simultaneous carotid endarterectomy.


METHODS
The axillo-axillary bypass was done in 39 patients who were monitored for 5.8 +/- 3.9 years. Fifteen of these patients with severe carotid artery disease had a carotid endarterectomy done simultaneously. Twenty-four patients had an axillo-axillary bypass alone; four of these patients later had a carotid endarterectomy at 0.5 to 10 years. Graft patency was evaluated at intervals of 6 to 12 months by clinical evaluation and noninvasive vascular studies.


RESULTS
Ten-year primary and secondary patency rates for all axillo-axillary bypass grafts were 88% and 91%, respectively. When carotid endarterectomy was done with axillo-axillary bypass, these patency rates were 86% and 93%, respectively. Patients with only axillo-axillary grafts had 10-year primary and secondary patency rates of 89% and 89%, respectively. Most patients had complete relief from symptoms of arm ischemia (90%) and vertebrobasilar insufficiency (85%). No perioperative mortality or permanent neurologic deficit occurred.


CONCLUSIONS
Axillo-axillary bypass is a safe and effective method for revascularization of the subclavian artery and should be considered for patients at high risk.
Chang
J B
JB
Long Island Vascular Center, Roslyn, NY 11576, USA.
Stein
T A
TA
Liu
J P
JP
Dunn
M E
ME
D000328:Adult; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001366:Axillary Artery / Q000503:physiopathology / Q000601:surgery*; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013348:Subclavian Artery / Q000503:physiopathology / Q000601:surgery*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency