title: Carotid-subclavian bypass for subclavian artery revascularization: long-term follow-up and effect of antiplatelet therapy.
abstract: Subclavian artery stenosis is found in up to 25% of supraaortic lesions. Bypass grafting is the procedure of choice but controversies exist concerning the optimal technique and the effect of postoperative antithrombotic therapy on long-term patency. The authors retrospectively analyzed 40 patients with carotid-subclavian bypasses. Stenoses were documented preoperatively by arteriography. Patency was determined by clinical, ultrasound, or arteriographic examinations. Cumulative patency rates were calculated by Kaplan-Meier method and analyzed by Tarone-Ware test. Graft materials were Dacron (32), polytetrafluoroethylene (seven) or saphenous vein (one). Indications for surgery included vertebrobasilar insufficiency (22.5%), upper extremity ischemia (22.5%), and the combination of both (55.0%). Perioperative mortality and morbidity were 2.5% and 10.0%, respectively. Patients were followed up from 0 to 134 months (mean 61+/-39 months). Cumulative 5-year patency rate was 83.3%. Anticoagulation with acetylsalicylic acid (ASA) led to significantly better 5-year patency rates (100%) as compared with the combination of ASA and dipyridamole (64.0%, p=0.013) or no anticoagulation (70.0%, p=0.016). Carotid-subclavian bypass led to excellent long-term patency rates and can provide durable relief of symptoms with minimal perioperative morbidity and mortality. Therefore, it is a worthwhile procedure to correct proximal subclavian artery stenosis. Postoperative medication with ASA seems to increase long-term bypass function significantly.
authors.affiliation: Surgical Center, Division of Cardiothoracic and Vascular Surgery, Hannover Medical School, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Wittwer
authors.forename: T
authors.initials: T
authors.lastname: Wahlers
authors.forename: C
authors.initials: C
authors.lastname: Dresler
authors.forename: A
authors.initials: A
authors.lastname: Haverich
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D000925:Anticoagulants / Q000627:therapeutic use; D001132:Arm / Q000098:blood supply; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D001241:Aspirin / Q000627:therapeutic use; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D002339:Carotid Arteries / Q000601:surgery*; D004176:Dipyridamole / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006801:Humans; D007511:Ischemia / Q000601:surgery; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D014463:Ultrasonography; D014654:Vascular Patency; D014715:Vertebrobasilar Insufficiency / Q000601:surgery
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D011093:Polyethylene Terephthalates; D004176:Dipyridamole; D011138:Polytetrafluoroethylene; D001241:Aspirin