SUPRAAORTIC BYPASS-GRAFTING FOR SUBCLAVIA N ARTERY-STENOSIS - IMMEDIATE RESULTS AND LONG-TERM OUTCOME - ARE EXTRAANATOMIC CONDUITS SUPERIOR

Subclavian artery stenosis is found in up to 25% of patients with supr aaortic lesions. Bypass grafting is the recommended procedure of choic e but there is still debate concerning the optimal technique. We there fore performed a retrospective analysis to determine the prognostic fa ctors based on long-term results. Between 1974 and 1992, fifty-five pa tients were treated for subclavian artery stenosis. The methods used w ere carotid-subclavian artery bypass (KSBP, n = 40) and aorto-subclavi an artery bypass (ASBP, n = 15). Indications for surgery included vert ebrobasilar insufficiency (20,0%), upper extremity ischemia (20%) and the combination of both (58.2%). Arteriosclerosis was the predominant cause of disease (85.5%). Peri-operative mortality was limited to one patient in the KSBP-group (2.5%). Post-operative morbidity was signifi cantly lower in the KSBP-group (10.0%) as compared to the ASBP-group ( 40.0%, p = 0.018). Relief of symptoms was achieved in 97.4% of KSBP pr ocedures and in 92.9% of ASBP procedures. Patients were followed up fo r a mean period of 73.7 +/- 58.0 months. Cumulative 5-year patency rat es of 71.4% (ASBP) and 83.3% (KSBP) were not significantly different b etween both groups (p = 0.089). Pharmacologic therapy with acetylsalic ylic acid (ASA) led to a statistically significantly better 5-year pat ency rate (100%) as compared to the combination of ASA and dipyridamol e (71,4%, p = 0.016) or phenprocoumone alone (50.0%, p < 0.001) or no anticoagulation (71.4%, p = 0.005). In our experience carotid-subclavi an bypass has an excellent long-term patency rare with a low peri-oper ative morbidity as compared to transthoracic bypass procedures (ASBP). Therefore KSBP should be the procedure of choice to correct proximal subclavian artery stenosis. Platelet inhibitors will increase bypass p atency rate significantly.