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Carotid-subclavian bypass: a twenty-two-year experience
M J Vitti1, B W Thompson, R C Read
1Department of Surgery, University of Arkansas for Medical Sciences, Little Rock.
Journal of Vascular Surgery
|September 1, 1994
Summary
Carotid-subclavian bypass is a safe and effective procedure for treating subclavian artery occlusive disease. This surgery offers durable symptom relief, especially for patients experiencing drop attacks or upper extremity ischemia.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Surgical Outcomes
Background:
- Subclavian artery occlusive disease can lead to serious neurological and limb ischemia symptoms.
- Carotid-subclavian bypass is a surgical option to restore blood flow.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of carotid-subclavian bypass.
- To assess primary patency and symptom resolution after the procedure.
Main Methods:
- Retrospective review of 124 patients undergoing carotid-subclavian bypass (1968-1990).
- Analysis of preoperative risk factors, perioperative outcomes (mortality, morbidity, graft type), and postoperative follow-up (patency, symptom recurrence, survival).
Main Results:
- 100% primary patency and symptom-free survival at 30 days.
- Long-term primary patency of 95% at 5 and 10 years, with 3 graft occlusions.
- Symptom recurrence in 10% of patients, with 5-year and 10-year symptom-free survival rates of 90% and 87%, respectively.
- High success rates for vertebrobasilar insufficiency and extremity ischemia.
Conclusions:
- Carotid-subclavian bypass is a safe and durable procedure for symptomatic subclavian artery occlusive disease.
- The surgery provides lasting relief, particularly for patients with drop attacks and upper extremity ischemia.