Carotid-Subclavian Bypass in Occlusive Disease of Subclavian Artery: More Important Today than Before

Abstract

After left internal mammary artery graft is anastomosed to the coronary artery, atherosclerotic occlusion of subclavian artery becomes more important, because the vascular segment between the origin of the subclavian artery and the coronary artery becomes a part of the coronary circulation functionally. The subclavian artery occlusion may be treated through percutaneous intervention including balloon angioplasty alone or with stent. But failure of initial treatment by percutaneous intervention is possible especially in some proximal and total occlusions. In those cases, surgical options include extraanatomic reconstruction, anatomic reconstruction with transthoracic approach or redo-coronary artery surgery in patients with coronary steal syndrome. In this retrospective study, the medical records of 66 patients underwent carotid-subclavian bypass under general or local anesthesia between January, 1990 and January, 2003 were reviewed to analyze the early and long-term results of carotidsubclavian bypass with polytetrafluoroethylene grafts. There were no intraoperative mortalities. There were only one peroperative cerebrovascular accident and one death due to myocardial ischemia early in the post-operative period. Over a mean follow up of 96 months (6 month-144 months), thirteen patients died due to various reasons and there were eleven late graft thrombosis. The primary patency rates at 1, 3, 5 and 10 years were 98%, 91%, 83% and 47%, and the overall survival rates at 1, 3, 5 and 10 years were 100%, 95%, 93% and 38%, respectively. Carotid-subclavian bypass with polytetrafluoroethylene grafts is a safe, effective and durable procedure. It can be easily applied even under regional anesthesia when percutaneous intervention is unsuccessful or impossible.carotid; subclavian; coronary artery; bypass

Slow Coronary Flow is Associated with Carotid Artery Dilatation

“…Although we used an advanced technique to evaluate carotid artery it can be done with simple duplex ultrasonographic scanning (Cinar et al 2004). As a conclusion, in the current study indicate that increased coronary and carotid diameter observed in SCF could be an early finding and may be used as an early indicator for SCF.…”

An alternative surgical approach to subclavian and innominate stenosis: a case series

“…Using the ascending aorta eliminates this risk. Patients who have or will have coronary revascularisation using an internal mammary artery as a conduit present a special problem in subclavian and innominate stenosis, as functionally the vascular segment between the origin of subclavian artery and the coronary artery becomes part of coronary circulation [10]. In such patients, the myocardium may be dependent on subclavian flow and care should be taken to ensure that whatever procedure is carried out, satisfactory antegrade flow to the relevant subclavian artery can be assured for the long term or alternatives should be sought for the internal mammary graft to prevent a coronary-subclavian steal syndrome and myocardial ischaemia.…”

Landmark-Wire Technique of Symptomatic Subclavian Artery Occlusion

“…A catheter and/or guidewire used as a landmark at the opposite end of an occlusion, can guide the probing direction thus preventing unnecessary vessel injury or repeated contrast agent injection during coronary angioplasty for chronic total occlusion 14 . The transbrachial approach can be tried first because the catheter and the guidewire are unstable in the aortic arch especially in cases of osteal occlusion 4 . However, in our series, we could pass the occluded lesion via the femoral route by using stable engagement of the guiding catheter and the rigid guidewires which were developed for the purpose of probing the occluded segment 13 .…”

“…However, traditional surgical treatment with subclavian-carotid bypass or transposition is frequently chosen for occluded SCA because of the difficulties encountered both passing through an occlusion and in stenting 4 . We present a safe and effective technique used while probing through the occluded segment of an SCA and leading to successful recanalization using a landmark at the opposite end of the occlusion.…”