Extrathoracic approach in surgical treatment of subclavian steal

Between 1979 and 1985 11 selected patients underwent axilloaxillary and carotid-subclavian bypass grafting [dacron or Gore-Tex (USA), 8 mm inner diameter]. Nine patients had lesions in the left subclavian artery and two patients presented with innominate artery obstruction with subclavian-carotid recovery phenomenon. All patients were symptomatic before surgery, and all were relieved of both cerebrovascular and upper extremity ischemic symptoms following surgery. Early graft patency has been excellent. There has been no mortality or serious postoperative complications. Two patients developed late graft thrombosis with recurrent ischemia of the left upper extremity, but there were no neurological symptoms. There has been a follow-up period of up to 6.5 years (mean 38.4 months.) It would appear that the appropriate extrathoracic route of revascularization is the procedure of choice for symptomatic patients with subclavian steal and subclavian-carotid recovery phenomenon.