ARTERIAL RECONSTRUCTION FOR SUBCLAVIAN OBSTRUCTIVE DISEASE - A COMPARISON OF EXTRATHORACIC PROCEDURES

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.