CONNECTED SURGERY OF CAROTID AND SUBCLAVI AN ARTERIES - INDICATIONS AND RESULTS

Over a 5 year period (1988-1992), 6 patients were treated by combined carotid and subclavian artery surgery, representing 0.7 % of carotid i nterventions practised during this period. The carotid lesion clinical stage was 0 (2 cases), 1 (2 cases) and 3 (2 cases). While for the sub clavian artery 4 patients were asymptomatic and 2 had vertebrobasilar syndromes, one associated with ischemia of upper limb. Only one patien t was globally asymptomatic but the diagnosis was a prethrombotic caro tid restenosis. Radiographs showed that the atheromatous lesion of the cervical trunks was equivalent to 2.83 stenoses per patient. The deci sion to use the combined interventions was based on either the clinica l condition (combined carotid and vertebrobasilar symptomatology) or h emodynamic data (improvement in subclavian flow during carotid surgery ). This hemodynamic component could be determined by transcranial Dopp ler. Operation consisted always of initial subclavian revascularizatio n (1 reimplantation, 5 bypasses), followed by carotid surgery (2 graft s, 4 endarterectomies). The postoperative course was uneventful in 5 p atients, the 6th patient requiring recovery surgery for early carotid thrombosis without worsening of the neurologic state. Mean follow up w as 9 months (range 1 to 27 months). Combining these two interventions in this small series did not appear to increase carotid surgery compli cation. Initial revascularization of the subclavian artery in the pati ent with multiple trunk lesions corrected the posterior hemodynamic su pply to the circle of Willis (J Mal Vasc, 1993, 18, pp. 265-268).