Long-term results with axillo-axillary bypass grafts for symptomatic subclavian artery insufficiency.

Abstract

The surgical treatment for patients with a subclavian steal is controversial, especially for patients with coexisting severe carotid stenosis. This study determines the long-term efficacy of axillo-axillary bypass grafts in patients with and without a simultaneous carotid endarterectomy. The axillo-axillary bypass was done in 39 patients who were monitored for 5.8 +/- 3.9 years. Fifteen of these patients with severe carotid artery disease had a carotid endarterectomy done simultaneously. Twenty-four patients had an axillo-axillary bypass alone; four of these patients later had a carotid endarterectomy at 0.5 to 10 years. Graft patency was evaluated at intervals of 6 to 12 months by clinical evaluation and noninvasive vascular studies. Ten-year primary and secondary patency rates for all axillo-axillary bypass grafts were 88% and 91%, respectively. When carotid endarterectomy was done with axillo-axillary bypass, these patency rates were 86% and 93%, respectively. Patients with only axillo-axillary grafts had 10-year primary and secondary patency rates of 89% and 89%, respectively. Most patients had complete relief from symptoms of arm ischemia (90%) and vertebrobasilar insufficiency (85%). No perioperative mortality or permanent neurologic deficit occurred. Axillo-axillary bypass is a safe and effective method for revascularization of the subclavian artery and should be considered for patients at high risk.