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Subclavian artery reconstruction in patients undergoing coronary artery bypass grafting
Masami Ochi1, Nobuo Hatori, Kazuhiro Hinokiyama
1Division of Cardiovascular Surgery, Department of Surgery II, Nippon Medical School, Tokyo, Japan.
Insights
Reconstructing subclavian artery (SCA) occlusive disease during coronary artery bypass grafting (CABG) is feasible. Aortoaxillary bypass grafts showed excellent mid-term patency, allowing the use of the left internal thoracic artery (LITA) in selected patients.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Interventional Cardiology
Background:
- Subclavian artery (SCA) occlusive disease proximal to the internal thoracic artery (ITA) origin impacts coronary artery bypass grafting (CABG) strategy and outcomes.
- SCA lesions necessitate tailored surgical approaches to ensure optimal graft perfusion and patient safety.
Purpose of the Study:
- To evaluate the safety and efficacy of simultaneous SCA reconstruction during CABG.
- To assess the mid-term patency of aortoaxillary bypass grafts.
- To determine the feasibility of utilizing the left internal thoracic artery (LITA) post-SCA reconstruction.
Main Methods:
- Retrospective analysis of 780 patients undergoing CABG, with 13 patients receiving concomitant SCA reconstruction.
- SCA reconstruction techniques included aortoaxillary bypass (n=9), carotid-subclavian (C-S) transposition (n=2), and percutaneous balloon angioplasty with stenting (n=2).
- Follow-up ranged from 4 to 8.4 years (mean 6.3 years).
Main Results:
- Aortoaxillary bypass grafts demonstrated 100% patency at mid-term follow-up.
- Carotid-subclavian transposition and angioplasty were performed safely and effectively, particularly in off-pump CABG.
- The LITA was successfully used as a coronary graft in 6 patients following SCA reconstruction.
Conclusions:
- Simultaneous aortoaxillary bypass for SCA reconstruction during CABG is safe and effective, with satisfactory mid-term graft patency.
- SCA reconstruction facilitates the use of the LITA for coronary artery bypass in selected patients.
- Preoperative brachial angiography is essential for identifying SCA disease in patients undergoing CABG.
Abstract:
The presence of occlusive disease of the subclavian artery (SCA) proximal to the origin of the internal thoracic artery (ITA) influences the operative strategy and the outcome of coronary artery bypass grafting (CABG). Of 780 patients who underwent CABG, concomitant SCA occlusive lesions were reconstructed in 13 patients (nine males, four females). The affected SCAs were left-sided in 11 patients, and right-sided and bilateral in one, each. An aortoaxillary bypass utilizing an 8-mm PTFE graft was constructed in nine patients and a carotid-subclavian (C-S) transposition in two, simultaneously with CABG. Percutaneous balloon angioplasty with a stent was performed in two patients prior to CABG. With follow-up periods ranging from 4 to 8.4 years (mean, 6.3 years), aortoaxillary bypass grafts were patent in all patients. Other reconstructive procedures, including a C-S transposition and balloon angioplasty, were performed safely and effectively in off-pump CABG patients. In six patients, the left internal thoracic artery (LITA) could be used as a graft to the coronary artery after SCA reconstruction. Aortoaxillary bypass using an 8-mm PTFE graft is a safe and effective way for simultaneous subclavian reconstruction in patients undergoing CABG. Mid-term patency of the graft is satisfactory. The LITA can be used as a graft to the coronary arteries in selected patients. Preoperative brachial angiography is mandatory in these patients.