Axilloaxillary bypass for symptomatic stenosis of the subclavian artery

Since the association has been made between stenosis of the subclavian artery and neurologic symptoms, controversy has existed over the preferred surgical procedure for bypass. In addition, concern has been raised regarding the long-term patency and effectiveness of this extraanatomic procedure in relieving neurologic symptoms. Twenty-seven patients underwent this operation for posterior cerebral symptoms between 1973 and 1982; 25 were followed for up to 77 months (mean 26 months). Twenty-two patients had complete relief of symptoms, although 3 of them required a subsequent carotid endarterectomy. Two other patients had partial relief, and one patient's symptoms remained unchanged. Upper extremity symptoms, present in nine patients, were relieved by the operation. All grafts remained patent during follow-up. Axilloaxillary bypass is a durable procedure for symptomatic stenosis of the subclavian artery. It is a low-risk procedure and is therefore particularly suited for older patients with associated carotid artery disease.