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Carotid-subclavian bypass with or without carotid endarterectomy
J O Defraigne1, D Remy, E Creemers
1Department of Cardiovascular Surgery, University Hospital Sart-Tilman, Liège.
Insights
Carotid-subclavian bypass effectively treats subclavian artery or left common carotid artery blockages. This safe surgical option provides high patency rates and symptom relief for patients with vertebrobasilar insufficiency or arm ischemia.
Area of Science:
- Vascular Surgery
- Cerebrovascular Surgery
- Arterial Revascularization
Background:
- Subclavian artery and left common carotid artery occlusive lesions can cause significant neurological and ischemic symptoms.
- Patients often present with vertebrobasilar insufficiency, arm ischemia, or a history of transient ischemic attack (TIA) or cerebrovascular accident (CVA).
- Associated internal carotid artery lesions are common in patients with subclavian disease.
Purpose of the Study:
- To evaluate the safety and efficacy of carotid-subclavian bypass for treating subclavian artery or left common carotid artery occlusive disease.
- To assess patency rates, symptom relief, and operative outcomes of this surgical procedure.
Main Methods:
- A retrospective review of 29 patients (1981-1987) who underwent carotid-subclavian bypass for subclavian or left common carotid artery occlusive lesions.
- Procedures utilized autogenous saphenous vein or prosthetic grafts, with some cases including simultaneous carotid endarterectomy.
- Patient data included symptomatology, arteriographic findings, operative details, and follow-up assessments.
Main Results:
- Operative mortality was low at 3.4%.
- Early patency ( < 1 month) was 97%, and late patency (mean follow-up 40 months) was 89%.
- 92% of patients experienced complete symptom relief, with no instances of carotid steal syndrome.
Conclusions:
- Carotid-subclavian bypass is a safe and effective revascularization strategy for selected patients with subclavian or left common carotid artery occlusive disease.
- Both autogenous vein and prosthetic grafts demonstrated comparable patency rates.
- The procedure offers significant symptom improvement and a low complication rate.
Abstract:
From 1981 to 1987, 29 patients (14 women and 15 men, with a mean age of 56 +/- 15 years) underwent a carotid-subclavian bypass for occlusive lesion of the subclavian artery (or of the left common carotid artery). The symptomatology included vertebrobasilar insufficiency, arm ischemic symptoms, or combination of both symptoms. Twelve patients (42%) have had a previous transient ischemic attack, or a cerebrovascular accident. There were 22 stenoses or occlusions of the left subclavian artery, and 6 of the right subclavian artery. On arteriography, 9 patients had significant associated lesions on the internal carotid artery, either homolateral (n = 7), or heterolateral, or bilateral. Carotid to subclavian bypasses were performed either with autogenous saphenous vein (n = 15), or with prosthetic graft (n = 14). In 5 cases, a carotid endarterectomy was done simultaneously to the bypass. Operative mortality was 3.4% (1/29). Early patency (less than 1 month) was 97% and late patency 89%, with a mean follow-up of 40 +/- 24 months. The patency rates were not significantly different whether a prosthesis or a vein was used for the bypass. All patients were improved and complete relief of symptoms was achieved in 92%. No patient experienced symptoms of carotid steal after the bypass. We concluded that carotid-subclavian bypass is a safe and efficient method for revascularization of the subclavian artery of of the left common carotid artery in selected cases.