title: Axilloaxillary bypass for the treatment of subclavian artery stenosis complicated by bilateral common carotid artery occlusion: technical case report.
abstract: OBJECTIVE
  We successfully treated a patient with stenosis of the left subclavian artery, complicated by bilateral common carotid artery occlusion, via axilloaxillary bypass surgery.
  
  
  METHODS
  A 67-year-old patient with a history of hypertension and cerebral infarction underwent neck irradiation for treatment of a vocal cord tumor. Three months later, he began to experience transient tetraparesis several times per day. The blood pressure measurements for his right and left arms were different. Supratentorial blood flow was markedly low. The common carotid arteries were bilaterally occluded, and the right vertebral artery was hypoplastic. Therefore, only the left vertebral artery contributed to the patient's cerebral circulation; his left subclavian artery was severely stenotic.
  
  
  METHODS
  The patient underwent axilloaxillary bypass surgery because the procedure avoids thoracotomy or sternotomy, manipulation of the carotid artery, and interruption of the vertebral artery blood flow. The patient has been free of symptoms for more than 5 years.
  
  
  CONCLUSIONS
  Neurosurgeons should be aware that extra-anatomic bypass surgery is an effective treatment option for selected patients with cerebral ischemia.
authors.affiliation: Department of Neurosurgery, Saiseikai Utsunomiya Hospital, Mibu, Tochigi, Japan. oginom-dky@umin.ac.jp
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ogino
authors.forename: Masashi
authors.initials: M
authors.lastname: Nagumo
authors.forename: Toru
authors.initials: T
authors.lastname: Nakagawa
authors.forename: Masashi
authors.initials: M
authors.lastname: Nakatsukasa
authors.forename: Ikuro
authors.initials: I
authors.lastname: Murase
mesh_terms: D000368:Aged; D001366:Axillary Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000601:surgery*; D016893:Carotid Stenosis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D002533:Cerebral Angiography; D002548:Cerebral Revascularization; D006801:Humans; D008297:Male; D013349:Subclavian Steal Syndrome / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D015899:Tomography, Emission-Computed, Single-Photon