CAROTID-SUBCLAVIAN BYPASS - A 22-YEAR EXPERIENCE

Purpose: A retrospective review of 124 patients who underwent carotid- subclavian bypass from 1968 to 1990 was done to assess primary patency and symptom resolution. Methods: Preoperative data included age, athe rosclerosis risk factors, and indications for surgery. Perioperative d ata included mortality and morbidity rates and graft conduit. Postoper ative follow-up assessed graft patency, resolution of symptoms, and la te survival. Results: Age ranged from 42 to 78 years (mean 57.9). Indi cations for surgery were vertebrobasilar insufficiency in 24 (19%), ex tremity ischemia (EI) in 33 (27%), transient ischemic attacks (TIAs) i n 13 (11%), both vertebrobasilar insufficiency and EI in 31 (25%), and both TLAs and EI in 23 (18%) patients. Graft conduits were polytetraf luoroethylene in 44 (35%) and Dacron in 80 (65%) cases. Concomitant ip silateral carotid endarterectomy was done in 32 (26%) patients. During operation, death occurred in one patient (0.8%), and complications oc curred in 10 (8%) patients. Thirty-day primary patency and symptom-fre e survival rates were 100%. Long-term follow-up ranging from 5 to 164 months was available for the 60 cases done between 1975 and 1990. Thre e grafts occluded at 30, 36, and 51 months after surgery for a primary patency rate of 95% at 5 and 10 years. Twenty-two patients died, yiel ding survival rates of 83% at 5 years and 59% at 10 years. Symptom rec urrence occurred in six (10%) patients from 9 to 66 months after surge ry. The symptom-free survival rate was 98% at 1 year, 90% at 5 years, and 87% gt 10 years. Symptoms recurred in three patients with occluded grafts and three with patent grafts. The preoperative symptoms of dro p attacks and TIAs did not recur. EI recurred in 5% and was noted only in the presence of graft occlusion. Dizziness recurred in 17% of pati ents admitted with this symptom and was observed despite graft patency . Conclusion: Carotid-subclavian bypass was a safe and durable procedu re for relief of symptomatic occlusive disease of the subclavian arter y. Long-term symptomatic relief appeared particularly likely in patien ts with drop attacks or upper extremity ischemia.