Subclavian to carotid artery transposition: medial versus lateral approach.
BACKGROUND
Subclavian to carotid transposition (SCT) is gaining importance as an adjunct for thoracic endovascular aortic repair (TEVAR). Two different anatomical approaches are described. We reviewed our experience with both approaches to evaluate the occurrence of complications and long-term outcome.


METHODS
We report the outcome of 150 SCTs carried between October 1979 and April 200710/79 at 2 university based tertiary care centers. Independent neurologic evaluation was performed.


RESULTS
Lateral and medial approaches were used in 83 (55.4%) and 67 (44.6%) cases, respectively. The internal thoracic artery and the thyrocervical trunk were sacrificed more frequently when the lateral approach was used (1.5% vs 39.8%; p=0.0001 and 1.5% vs 49.4%; p=0.0001, respectively). The medial approach was associated with significantly less complications (8, 11.9%, compared to 24, 28.9%, p=0.012). Thirty day mortality was 0.7%. Median follow-up was 36 months (1-227), and no subclavian artery occlusions were identified.


CONCLUSIONS
SCT is a durable procedure for the management of occlusive pathologies of the proximal subclavian artery occlusion. The medial approach is associated with significantly fewer complications.
Domenig
C M
CM
Division of Vascular Surgery, Vienna General Hospital, Vienna Medical School, Vienna, Austria. christoph.domenig@meduniwien.ac.at
Linni
K
K
Mader
N
N
Kretschmer
G
G
Magometschnigg
H
H
Hölzenbein
T J
TJ
D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D002339:Carotid Arteries / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013348:Subclavian Artery / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods*