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Is there a conduit of preference for a bypass between the carotid and subclavian arteries?
A Y Synn1, R T Chalmers, W J Sharp
1Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242-1083.
Insights
Autogenous vein grafts offer superior long-term patency for carotid-subclavian artery bypasses, especially for longer reconstructions to the carotid bifurcation. Prosthetic grafts showed lower patency in these specific cases.
Area of Science:
- Vascular Surgery
- Cardiovascular Research
- Surgical Outcomes
Background:
- The optimal conduit for carotid-subclavian artery bypass is debated.
- Bypass surgery is performed to restore blood flow between these major arteries.
Purpose of the Study:
- To compare the long-term efficacy and patency of prosthetic versus autogenous vein conduits for carotid-subclavian artery bypass.
- To identify specific anatomical configurations where one conduit type outperforms another.
Main Methods:
- Retrospective analysis of 32 patients undergoing carotid-subclavian artery bypass.
- Evaluation of perioperative mortality, stroke-free survival, neurologic symptom-free survival, and primary patency rates.
- Comparison of outcomes based on conduit type (prosthetic vs. autogenous vein) and bypass length/configuration.
Main Results:
- Overall, no significant difference in patency between prosthetic and vein conduits.
- For bypasses from the subclavian artery to the carotid bifurcation, vein grafts achieved 100% primary patency versus 40% for prosthetic grafts (p < 0.05).
- No patency difference was observed for shorter bypasses between the proximal common carotid and subclavian arteries.
Conclusions:
- Autogenous vein conduits demonstrate superior primary patency compared to prosthetic grafts for longer carotid-subclavian artery bypasses extending to the carotid bifurcation.
- The choice of conduit may be influenced by the specific anatomical requirements of the bypass.
- Vein grafts are recommended for longer reconstructions in this surgical context.
Abstract:
The conduit of choice for a bypass between the carotid and subclavian arteries remains controversial. We retrospectively evaluated 32 patients who underwent bypass between the carotid and subclavian arteries. Perioperative mortality was limited to a single patient who sustained a myocardial infarction. Long-term follow-up (mean: 46 months) revealed an 87% stroke-free survival rate, a 74% neurologic symptom-free survival rate, and a 77% primary patency rate at 5 years. No overall difference was discerned between a prosthetic or autogenous vein conduit. However, in bypasses constructed from the subclavian artery to the level of the carotid bifurcation, 100% (nine of nine) of vein bypasses remained primarily patent compared with 40% (two of five) of prosthetic grafts (p < 0.05). No distinct patency difference was identified between a short vein or a prosthetic bypass constructed between the proximal common carotid artery and subclavian artery. A vein bypass results in superior patency compared with a prosthetic graft for longer bypasses constructed from the subclavian artery to the carotid artery bifurcation.