Surgical treatment of atherosclerotic lesions of subclavian artery: carotid-subclavian bypass versus subclavian-carotid transposition

Background. The aim of this retrospective study is to analyze the short and long term results of two different surgical treatments in patients with su bclavian lesions: common carotid-subclavian artery bypass (CSB) versus tran sposition of subclavian artery on the common carotid artery (SCT). Methods, From 1981 until 1995, 40 non randomized patients with symptomatic subclavian steal underwent 20 CSBs and 20 SCTs. Risk factor rates were equa lly balanced in the two groups. Surgery was carried out routinely under gen eral anesthesia, with electroencephalic continuous monitoring. Patency of r evascularization was assessed by physical examination, brachial blood press ure determinations, ultrasound sonography and angiography whenever recurren ce of symptoms developed or when the function of repair was in doubt. Patie nts were examined every year. In Spring 1996 (range 9-189 mos, average 7 ye ars) a general clinical-instrumental followup was performed. Results. In the short term (<30 days) mortality was 5%: one death (5%) for pulmonary embolism in a patient with CSB and one for myocardial infarction in a patient with SCT. The early thrombosis rate was 5% (1 CSB and 1 common carotid artery distal to a patent SCT). During follow-up 10 patients (25%) died and 6 were lost. The six-year actuarial patency rate was 100% for SCT and 66% for CSB, Moreover there were 3 thromboses of the vertebral artery homolateral to patent CSBs. Conclusions. In conclusions SCT should be considered the surgical technical choice for the treatment of proximal subclavian artery lesions.