title: [Routine subclavian revascularisation employing regional anaesthesia].
abstract: BACKGROUND
  The increasing incidence of endovascular surgery on the thoracic aorta (TEVAR) is leading to an increased rate of subclavian-carotid transposition (SCT). Intentional overstenting of the left subclavian artery extends the proximal landing zone. If overstenting leads to a subclavian steal syndrome, vertebrobasilar insufficiency or if the risk of spinal ischaemia is present, SCT can safely be carried out with regional anaesthesia by means of a cervical block.
  
  
  METHODS
  Since January 2010 regional anaesthesia was employed in 13 consecutive patients receiving an SCT in our clinic. Subclavian revascularisation was performed either as adjunct procedure for TEVAR or in patients with occlusive disease of the aortic arch. The clinical course was prospectively observed.
  
  
  RESULTS
  In 62 % of the cases (n = 8) a transposition of the subclavian artery onto the common carotid artery was carried out. In 38 % of the cases (n = 5) an intraoperative decision was made to construct a carotid-subclavian bypass. In 30 % (n = 4) of the cases a conversion from cervical block to general anaesthesia was necessary. All reconstructions proved to be patent at follow-up.
  
  
  CONCLUSIONS
  Subclavian-carotid transposition under regional anaesthesia is safe and technically feasible if occlusion of the subclavian artery by thoracic stentgraft or stenosis has occurred. The technique employing regional anaesthesia can, therefore, also be offered to patients with increased risk for complications due to general anaesthesia.
authors.affiliation: Klinik für Gefäß- und Endovascularchirurgie, Klinikum der J. W. Goethe-Universität Frankfurt am Main, Deutschland.
authors.forename: N H
authors.initials: NH
authors.lastname: Clausen
authors.affiliation: Klinik für Anästhesie, Intensivmedizin und Schmerztherapie, Klinikum der J. W. Goethe-Universität Frankfurt am Main, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Byhahn
authors.affiliation: Klinik für Gefäß- und Endovascularchirurgie, Klinikum der J. W. Goethe-Universität Frankfurt am Main, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Schmitz-Rixen
authors.affiliation: Klinik für Anästhesie, Intensivmedizin und Schmerztherapie, Klinikum der J. W. Goethe-Universität Frankfurt am Main, Deutschland.
authors.forename: K
authors.initials: K
authors.lastname: Zacharowski
authors.affiliation: Klinik für Gefäß- und Endovascularchirurgie, Klinikum der J. W. Goethe-Universität Frankfurt am Main, Deutschland.
authors.forename: T C
authors.initials: TC
authors.lastname: Schmandra
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D000765:Anesthesia, Conduction / Q000379:methods*; D001013:Aorta, Thoracic / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D017536:Carotid Artery, Common / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods*; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D020760:Spinal Cord Ischemia / Q000209:etiology / Q000601:surgery*; D013348:Subclavian Artery / Q000601:surgery*; D013349:Subclavian Steal Syndrome / Q000209:etiology / Q000601:surgery*; D014715:Vertebrobasilar Insufficiency / Q000209:etiology / Q000601:surgery*