Subclavian artery revascularization: A decade of experience with extrathoracic bypass procedures

Tarek A. Salam, Alan B. Lumsden, Robert B. Smith

Research output: Contribution to journalArticle

31 Scopus citations

Abstract

Extrathoracic revascularization has become the most popular form of surgical correction of symptomatic subclavian artery lesions. During a 10-year period ending in December 1991, 41 extrathoracic bypass procedures were performed on 37 patients for proximal subclavian artery stenosis or occlusion. This included 25 females and 12 males, with a mean age of 56 years. Surgery was performed for manifestations of upper extremity ischemia in 19 patients (51%), vertebrobasilar insufficiency in four patients (11%), and both upper extremity ischemia and vertebrobasilar insufficiency in 11 patients (30%). Three patients (8%) had angina pectoris caused by “coronary-subclavian steal” following internal mammary-coronary artery bypass. Severe proximal stenosis or complete occlusion of the subclavian artery was demonstrated angiographically in all cases. Procedures performed included: carotid-subclavian bypass (n = 28), subclavian-carotid transposition (n = 6), axilloaxillary bypass (n = 4), and subclavian-subclavian bypass (n = 3). Saphenous vein was used as the bypass conduit in 6 of the carotid-subclavian bypass procedures, and prosthetic grafts were used for the remainder. There were no perioperative strokes or deaths in this series, and the mean postoperative hospital stay was 4 days. Follow-up ranged from 2 to 96 months (mean, 35.6 months). The overall patency rate was 95% at 1 year, 86% at 3 years, and 73% at 5 years. Patency at 5 years was significantly higher for procedures utilizing the common carotid artery as the donor vessel as compared with those using the contralateral subclavian or axillary arteries (83% versus 46%, P < 0.01). Two patients had recurrence of symptoms despite patency of the graft, and there was one death during the follow-up period that was unrelated to the revascularization procedure. This experience shows that extrathoracic bypass procedures are efficient, safe, and well-tolerated and offer long-term patency in the treatment of symptomatic subclavian stenosis or occlusion. Whenever possible, the ipsilateral common carotid should be used as the donor artery in these cases.

Original languageEnglish (US)
Pages (from-to)387-392
Number of pages6
JournalJournal of Surgical Research
Volume56
Issue number5
DOIs
StatePublished - Jan 1 1994

ASJC Scopus subject areas

  • Surgery

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