Ja. Vandervliet et al., ARTERIAL RECONSTRUCTION FOR SUBCLAVIAN OBSTRUCTIVE DISEASE - A COMPARISON OF EXTRATHORACIC PROCEDURES, European journal of vascular and endovascular surgery, 9(4), 1995, pp. 454-458
Objectives: Comparison of the immediate and long-term results of three
different extrathoracic arterial reconstruction procedures for subcla
vian obstructive disease. Design: Retrospective analysis of 51 extrath
oracic subclavian artery reconstructions in 49 patients performed in a
single centre over an 18-year period (mean follow-up 64 months, range
3-192). Methods: Carotid-subclavian bypass (CSB, n = 21), subclavian-
carotid transposition (SCT, n = 21) and subclavian-subclavian or axill
o-axillary cross-over bypass (COB, n=9) was performed. Upper extremity
ischaemic complaints were present in 45/49 patients (92%) and vertebr
obasilar insufficiency in 25/49 patients (51%). Symptom relief, improv
ement of haemodynamic parameters and graft patency were compared. Resu
lts: Operation time was significantly shorter (p < 0.001, t-test) in S
CT (80 +/- 5 min) compared to CSB (112 +/- 7 min) and COB (116 +/- 6 m
in). Symptom relief and improvement of haemodynamic parameters were si
milar for all groups. There were no differences in morbidity rate and
there was no mortality Tire cumulative patency of SCT was significantl
y better with 100% at 2, 5 and 10 years postoperatively compared to CS
B (75.6%, 62.6% and 52.2%, respectively) (p < 0.005, log-rank test) an
d COB (76.5%, 63.7% and 63.7%, respectively) (p < 0.02, log-rank test)
. There was a tendency for a better patency in prosthetic grafts as co
mpared to autologous vein grafts in CSB (NS, log-rank test). Conclusio
ns: Satisfactory immediate and long-term results were obtained with al
l of the above techniques. When technically feasible SCT is the proced
ure of choice for extrathoracic arterial reconstruction in subclavian
obstructive disease.