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Subclavian revascularization. A quarter century experience
W H Edwards1, S S Tapper, W H Edwards
1Department of Surgery, St. Thomas Hospital, Nashville, Tennessee.
Annals of Surgery
|June 1, 1994
Summary
Subclavian carotid transposition offers excellent long-term patency for subclavian artery disease. This extrathoracic revascularization technique demonstrates superior results compared to bypass procedures.
Area of Science:
- Vascular Surgery
- Surgical Outcomes
- Arterial Revascularization
Background:
- Proximal subclavian stenosis management is debated.
- Extrathoracic revascularization is preferred.
- Techniques include bypass and transposition.
Purpose of the Study:
- Review 25 years of extrathoracic subclavian revascularization experience.
- Determine long-term patency rates of different approaches.
- Evaluate subclavian carotid transposition (SCT) efficacy.
Main Methods:
- Retrospective review of 190 extrathoracic subclavian revascularizations.
- Analysis of patient records for 25 years.
- Patency assessed via physical exam, blood pressure, Doppler, duplex, and arteriography.
Main Results:
- Subclavian carotid transposition (SCT) performed in 178 cases.
- One anastomosis failure at 26 months; overall patency exceptional.
- Mean follow-up 46 months; overall mortality 2.2% (1.1% for SCT).
Conclusions:
- Subclavian carotid transposition is the preferred treatment for subclavian carotid occlusive disease.
- SCT demonstrates exceptional long-term patency.
- SCT offers low morbidity and superior outcomes.