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Late results after extra-anatomic bypass routes
Insights
Carotid-subclavian grafts show excellent 100% patency after three years, making them a preferred surgical option. Femoro-femoral bypasses had 79.7% patency, while axillo-femoral grafts are recommended only for specific infected cases.
Area of Science:
- Vascular Surgery
- Surgical Outcomes
- Reconstructive Procedures
Background:
- Subclavian artery lesions can lead to significant upper extremity ischemia.
- Various surgical bypass techniques exist for treating these conditions, each with distinct long-term patency rates.
- Optimal graft selection remains crucial for successful vascular reconstruction.
Purpose of the Study:
- To evaluate the long-term efficacy and outcomes of carotido-subclavian grafts.
- To compare the patency rates of femoro-femoral and axillo-femoral bypasses.
- To establish guidelines for the routine use of axillo-femoral bypass surgery.
Main Methods:
- Retrospective analysis of 37 carotido-subclavian grafts.
- Assessment of long-term patency for femoro-femoral bypasses (3-5 years).
- Evaluation of patency in 7 axillo-femoral grafts.
Main Results:
- Carotido-subclavian grafts achieved 100% patency through the third postoperative year with 0% operative mortality.
- Femoro-femoral bypasses demonstrated a long-term patency of 79.7% between the third and fifth years.
- Axillo-femoral grafts showed a 71.4% patency rate (5 out of 7 grafts).
Conclusions:
- Carotido-subclavian grafting is a highly effective and preferred method for subclavian lesion correction.
- Axillo-femoral bypass should be reserved for patients with infected aortoiliac segments, not as a routine procedure.
Abstract:
The long-term results of 37 carotido-subclavian grafts was 100% till the end of the third year. This method is now our preferred method for correction of subclavian lesions. The operative mortality was 0%. The long-term results of the femoro-femoro bypasses was 79.7% from the third through the fifth year. 5 out of 7 axillo-femoral grafts remained patent. In our opinion the axillo-femoral bypass should only implanted in patients with an infected area in the aortoiliac segment but not routinally.