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Subclavian artery revascularization: a comparison between carotid-subclavian artery bypass and subclavian-carotid
A V Sterpetti1, R D Schultz, C Farina
1Department of Surgery, Creighton University School of Medicine, Omaha, Neb.
Insights
Subclavian-carotid transposition (SCT) offers superior long-term results for symptomatic subclavian artery disease compared to carotid-subclavian bypass (CSB). SCT demonstrates better patency and hemodynamic stability, making it the preferred surgical option.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Surgical Outcomes
Background:
- Extrathoracic revascularization is a common treatment for symptomatic subclavian artery disease.
- Subclavian-carotid transposition (SCT) has theoretical advantages but limited adoption.
- Carotid-subclavian bypass (CSB) is a frequently used alternative.
Purpose of the Study:
- To compare the outcomes of carotid-subclavian bypass (CSB) and subclavian-carotid transposition (SCT) in patients with symptomatic subclavian artery disease.
- To evaluate the long-term patency and hemodynamic status of these surgical reconstructions.
- To determine the optimal surgical approach for this condition.
Main Methods:
- A 15-year retrospective study involving 46 patients with symptomatic subclavian artery occlusion.
- Patients underwent either carotid-subclavian bypass (CSB) or subclavian-carotid transposition (SCT).
- Follow-up ranged from 2 to 148 months, assessing patency rates and hemodynamic changes.
Main Results:
- Seven-year actuarial patency was 100% for SCT versus 86% +/- 7% for CSB (not significant).
- SCT showed significantly reduced operative time and blood loss compared to CSB (p < 0.05).
- CSB reconstructions demonstrated continuous hemodynamic deterioration, unlike SCT (p < 0.05).
Conclusions:
- Subclavian-carotid transposition (SCT) is associated with superior long-term patency and hemodynamic stability.
- SCT offers reduced operative time and blood loss.
- SCT should be considered the preferred surgical option for symptomatic severe subclavian artery disease when feasible.
Abstract:
Extrathoracic revascularization has become the most popular form of surgical treatment of symptomatic subclavian disease. Despite the many theoretical advantages, subclavian-carotid transposition (SCT) has not gained wide popularity. During a 15-year period, 46 patients underwent carotid-subclavian bypass (CSB) or SCT for symptoms referable to occlusion of the subclavian artery. Follow-up ranged from 2 to 148 months (mean, 46.9 months). Seven-year actuarial patency rate was 100% for SCT and 86% +/- 7% for CSB (p = NS). Mean operative time and intraoperative blood loss were significantly reduced for SCT (p less than 0.05). After CSB a continuous deterioration of the hemodynamic status of the reconstruction was noted, whereas there were no significant changes after SCT (p less than 0.05). Whenever feasible, SCT should be considered the operation of choice for patients with symptomatic severe subclavian artery disease.