Comparison of carotid-subclavian vs carotid-axillary bypass: A multicenter study of 238 patients

The purpose of our multicenter study was to compare the outcome (left subclavian artery [LSA] patency and reintervention) of carotid-subclavian bypass (distal anastomosis supraclavicular) vs carotid-axillary bypass (distal anastomosis infraclavicular), as well as analyzing and comparing possible complications such as phrenic nerve injury and lymph leakage.

This multicenter retrospective, observational study included a total of 238 patients who underwent open procedures involving the carotid-axillary bypass (CA) (n = 51) or carotid-subclavian bypass (CB) (n = 187) between January 2011 and December 2022.

The mean age of the patients was 64.2 ± 0.8 years (CA, 64.9 ± 1.6 vs CS, 64.07± 0.9). The mean follow-up was 19.4 ± 2.4 months. The most common diagnosis for open LSA revascularization was debranching owing to landing zone preparation during thoracic endovascular aortic repair for aortic aneurysm (n = 100 [42%]) and aortic dissection (n = 81 [34%]). Forty patients (16.8%) were operated owing to a symptomatic occlusion of the subclavian artery. Postoperative complications such as stroke, laryngeal nerve palsy, myocardial infarct, in-hospital mortality, and 30-day bypass occlusion did not differ between the groups. Only patients with the CS experienced postoperative phrenic nerve injury (P = .002) and lymphatic leakage (P = .039). A comparison of bypass-related reintervention between the patients showed no significant difference between the groups (P = .735).

The open surgical revascularization of LSA using the axillary artery as the distal bypass target is a safe alternative to traditional CS. It requires a more superficial approach and reduces the incidence of well-known complications such as phrenic nerve affection and lymphatic leakage.