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Operative correction of obstructed subclavian or innominate arteries
Insights
Surgical repair of subclavian or innominate artery occlusive disease using carotid-subclavian grafts offers a low mortality rate and good patency. Prioritize correcting brachiocephalic lesions in patients with lower extremity vascular insufficiency.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
Background:
- Occlusive disease of the subclavian or innominate arteries affects patients with neurologic or arm ischemia symptoms.
- A significant number of patients present with combined symptoms or associated lower extremity vascular insufficiency.
Purpose of the Study:
- To evaluate the outcomes of surgical interventions for subclavian and innominate artery occlusive disease.
- To compare the efficacy and safety of different surgical approaches and graft types.
Main Methods:
- Retrospective analysis of 82 operations on 79 patients with subclavian or innominate artery occlusive disease over 16 years.
- Surgical approaches included extrathoracic (67 cases) and transthoracic (15 cases).
- Graft types evaluated included long subcutaneous axilloaxillary, axillocarotid, and carotid-subclavian grafts.
Main Results:
- Transthoracic approach was associated with higher early mortality (20%) and morbidity (20%).
- Long subcutaneous grafts showed susceptibility to thrombosis and skin erosion.
- Carotid-subclavian grafts (57 cases) demonstrated high patency, low mortality (1.5%), and no "carotid steal" phenomenon.
Conclusions:
- Carotid-subclavian grafts are a safe and effective treatment for innominate and subclavian artery occlusive disease.
- The extrathoracic approach is preferable due to lower associated risks.
- Brachiocephalic lesions should be addressed before managing lower extremity vascular insufficiency when both conditions are present.
Abstract:
We have performed 82 operations on 79 individuals with occlusive disease of the subclavian or innominate arteries during the past 16 years. The left subclavian was occluded in 63, the right in nine, and the innominate in seven. Presenting symptomatology was neurologic in 29, arm ischemia in 24, and combined in 23. Blood pressure was reduced by 30 mm Hg on the involved side in all. An extrathoracic approach was used in 67 and a transthoracic approach in 15. Early mortality (20%) and morbidity (20%) were associated with the transthoracic approach. Long subcutaneous axilloaxillary and axillocarotid grafts are prone to thrombosis and skin erosion. Carotid-subclavian grafts used in 57 remain patent, are associated with a low mortality (1.5%), and do not develop "carotid steal." When associated with vascular insufficiency of the lower extremity (44%) the brachiocephalic lesion should be corrected first.