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Carotid-Subclavian Bypass for Subclavian Artery Revascularization: Long-term Follow-up and Effect of Antiplatelet Therapy

Surgical Center, Division of Cardiothoracic and Vascular Surgery, Hannover Medical School, Hannover, Germany.

Thorsten Wahlers, MD

Surgical Center, Division of Cardiothoracic and Vascular Surgery, Hannover Medical School, Hannover, Germany.

Christoph Dresler, MD

Surgical Center, Division of Cardiothoracic and Vascular Surgery, Hannover Medical School, Hannover, Germany.

Axel Haverich, MD

Surgical Center, Division of Cardiothoracic and Vascular Surgery, Hannover Medical School, Hannover, Germany.

Subclavian artery stenosis is found in up to 25% of supraaortic lesions. Bypass grafting is the procedure of choice but controversies exist concerning the optimal technique and the effect of postoperative antithrombotic therapy on long-term patency.

The authors retrospectively analyzed 40 patients with carotid-subclavian bypasses. Stenoses were documented preoperatively by arteriography. Patency was determined by clinical, ultrasound, or arteriographic examinations. Cumulative patency rates were calcu lated by Kaplan-Meier method and analyzed by Tarone-Ware test.

Graft materials were Dacron (32), polytetrafluoroethylene (seven) or saphenous vein (one). Indications for surgery included vertebrobasilar insufficiency (22.5%), upper extremity ischemia (22.5%), and the combination of both (55.0%). Perioperative mortality and morbidity were 2.5% and 10.0%, respectively. Patients were followed up from 0 to 134 months (mean 61 ±39 months). Cumulative 5-year patency rate was 83.3%. Anticoagulation with acetylsalicylic acid (ASA) led to significantly better 5-year patency rates (100%) as compared with the combination of ASA and dipyridamole (64.0%, p=0.013) or no anticoagulation (70.0%, p=0.016).

Carotid-subclavian bypass led to excellent long-term patency rates and can provide durable relief of symptoms with minimal perioperative morbidity and mortality. Therefore, it is a worthwile procedure to correct proximal subclavian artery stenosis. Postoperative medication with ASA seems to increase long-term bypass function significantly.

Angiology, Vol. 49, No. 4, 279-287 (1998)
DOI: 10.1177/000331979804900406


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