CAROTID-SUBCLAVIAN BYPASS FOR BRACHIOCEPHALIC OCCLUSIVE DISEASE - CHOICE OF CONDUIT ACID LONG-TERM FOLLOW-UP

Background and Purpose Atherosclerotic disease of the proximal brachio cephalic circulation may produce disabling symptoms referable to cereb ral or upper extremity hypoperfusion and embolization. Bypass of occlu sive lesions can provide durable relief of symptoms with minimal compl ications. The ideal conduit for carotid-to-subclavian and subclavian-t o-carotid bypass remains controversial, and it is not clear whether th e outflow vessel influences patency and survival. Methods We performed a retrospective analysis of 60 consecutive carotid-to-subclavian and subclavian-to-carotid bypass procedures. Occlusive lesions were docume nted preoperatively by arteriography. Patency was determined during fo llow-up by ultrasound or duplex examination. Actuarial patency, sympto m-free survival, and overall survival rates were calculated by the lif e-table method and analyzed by log-rank test. Results Arterial transpo sition demonstrated the highest long-term patency rate (100.0+/-0.0%). Polytetrafluoroethylene grafts demonstrated the highest bypass graft patency rate (95.2+/-4.6%), followed by Dacron grafts (83.9+/-10.5%) a nd saphenous vein grafts (64.8+/-16.5%). Symptom-free survival paralle led patency rates, but these differences did not achieve statistical s ignificance. While there were no differences in patency or symptom-fre e survival by outflow vessel, the overall survival of patients with co mmon carotid lesions was significantly lower than that of patients wit h subclavian lesions (62.7+/-12.8% versus 100.0+/-0.0%; P<.05). Conclu sions The outflow vessel does not affect long-term patency in carotid and subclavian bypass procedures; however, patients with common caroti d disease demonstrate significantly poorer long-term survival. Transpo sition results in superior long-term patency, with a trend toward lowe r results for synthetic grafts and relatively poor results for autogen ous vein grafts.