The long-term outcome after axillo-axillary bypass grafting for proximal subclavian artery disease.
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OBJECTIVES: to investigate the outcome of patients undergoing axillo-axillary bypass grafting for symptomatic subclavian artery stenoses or occlusions. DESIGN: retrospective case-note review and prospective review of patients available for follow-up. PATIENTS AND METHODS: sixteen patients had axillo-axillary grafts in a 17-year period. Ten patients were available for review and assessed clinically, by measurement of arm blood pressures, and by duplex scanning of their grafts. RESULTS: one patient died and three grafts occluded within 30 days of operation. Nine out of 10 grafts scanned were patent, with three further grafts clinically patent at death. Overall secondary patency was 75% at a combined median follow-up of 56 months (range 12-204 months). Recurrent symptoms occurred in two patients, one with an occluded graft and one with a patent graft. CONCLUSION: axillo-axillary bypass grafts give good long-term symptom-free results. (+info)
Carotid-subclavian bypass grafting with polytetrafluoroethylene grafts for symptomatic subclavian artery stenosis or occlusion: a 20-year experience.
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BACKGROUND AND PURPOSE: Since the advent of subclavian artery percutaneous transluminal angioplasty/stenting, several authorities advocate it as the treatment of choice for patients with subclavian artery disease, claiming results equal to or better than those of reconstructive vascular surgery. However, most of their quoted surgical series included patients who may have other brachiocephalic disease who were treated nonuniformly by means of various bypass grafts with different grafts in the same series (eg, Dacron, polytetrafluoroethylene [PTFE], or vein). In this study, we analyze the long-term results of a large series of carotid-subclavian bypass grafts for subclavian artery disease in which PTFE was uniformly used; the study can be used as a future reference to compare the results of subclavian artery percutaneous transluminal angioplasty/stenting. PATIENT POPULATION AND METHODS: Fifty-one patients with symptomatic subclavian artery disease (40 occlusions and 11 stenoses) who were treated with carotid-subclavian bypass grafts (PTFE [Goretex]) during a 20-year period were analyzed. Graft patency was determined clinically and confirmed with Doppler scanning pressures and duplex ultrasound scanning. The cumulative patency, overall survival, and symptom-free survival rates were calculated with the life table method. RESULTS: Indications for surgery were arm ischemia in 34 patients (67%), vertebrobasilar insufficiency (VBI) in 27 (53%), and symptomatic subclavian steal in 7 (14%). A combination of arm ischemia and VBI occurred in 17 (33%) of these patients. The mean follow-up was 7.7 years with a median of 7.0 years (range, 1-19 years). The 30-day morbidity rate was 6%, with no perioperative stroke or mortality. Immediate relief of symptoms was achieved in 100% of patients; however, four patients (8%) had late recurrent symptoms (three with VBI). The primary patency and secondary patency rates at 1, 3, 5, and 10 years were 100%, 98%, 96%, and 92% and 100%, 98%, 98%, and 95%, respectively. The symptom-free survival rates at 1, 3, 5, and 10 years were 100%, 96%, 82%, and 47%, respectively. The overall survival rates at 1, 3, 5, and 10 years were 100%, 98%, 86%, and 57%. The mean hospital stay was 3.5 days in the late 70s and 80s and 2.1 days in the 90s (P <. 001). CONCLUSIONS: Carotid-subclavian bypass grafts with PTFE grafts for subclavian artery disease are safe, effective, and durable and should remain the procedure of choice, particularly in good-risk patients. (+info)
Subclavian artery disruption resulting from endovascular intervention: treatment options.
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Endovascular intervention is a commonly accepted form of treatment in patients with subclavian artery stenosis. Complications will undoubtedly occur as the utility of catheter-based intervention continues to rise. We report two cases of subclavian artery disruption as a result of endovascular intervention. One patient had contrast extravasation after the deployment of a balloon-expandable stent in a stenotic subclavian artery, and the arterial injury was successfully treated with balloon tamponade. A second patient had a large subclavian pseudoaneurysm 4 months after a balloon-expandable stent placement. Successful repair was achieved in this patient by means of arterial reconstruction with a prosthetic bypass graft. These cases illustrate different therapeutic methods of treating subclavian artery rupture due to endovascular intervention. (+info)
Ultrasound of the carotid and vertebral arteries.
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Ultrasound plays an important role in the assessment of carotid arterial disease, complimentary to other imaging modalities. However, ultrasound does have limitations, not least the requirement of a high degree of operator skill. Recent advances in ultrasound technology will strengthen its role by improving accuracy. This review discusses the role of ultrasound in assessing the carotid arterial system with emphasis on evaluating stenosis. (+info)
Subclavian steal syndrome from high-output brachiocephalic arteriovenous fistula: a previously undescribed complication of dialysis access.
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A 28-year-old dialysis-dependent man presented with episodic vertebrobasilar insufficiency. Noninvasive studies demonstrated an estimated 5.8 L/min flow through the arteriovenous fistula in his left arm and reversal of flow in the left vertebral artery. Surgical reduction of fistula flow resulted in the elimination of symptoms and the return of antegrade flow in the left vertebral artery. intraoperative invasive monitoring corroborated the pressure gradient responsible for his subclavian steal syndrome. (+info)
Combined cerebral and lower-limb revascularization.
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Brachiocephalic atherosclerosis and aortoiliac occlusive disease are often encountered concomitantly, The authors report a technique of combined brachiocephalic and femoral revascularization in which a single transthoracic approach is used. (+info)
Subclavian steal syndrome: report of 28 cases.
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OBJECTIVE: To study the experience in the treatment of subclavian steal syndrome (SSS) and the relation between SSS and the damage of brain. METHODS: In 28 patients with SSS, 23 were operated on. They complained of vertigo, TIA, and claudication of arms. One patient suffered from severe stem ischemia spasm. All the patients were subjected to subtraction angiography. Fifteen of them showed retrograde flow in the vertebral arteries. Transcranial Doppler revealed retrograde blood flow in 8 patients. Single photon emission tomography showed inadequate blood supply to the brain with affected subclavian arteries in 4 patients. Carotid-subclavian arterial bypass was performed in 16 patients, axilloauxillary bypass in 3, PTA in 1, and aorta-carotid graft bypass in 3. RESULTS: 13 patients (13/23) had their cerebrovascular symptoms relieved. Transcranial Doppler and emission tomography after operation showed nothing abnormal. CONCLUSION: SSS is harmful and the patients should be closely monitored by means of transcranial Doppler and emission tomography. (+info)
Coronary subclavian steal syndrome: treatment by stenting of the left subclavian artery.
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A 48-year-old Turkish male presented with worsening angina and a painful left hand eight years after coronary artery bypass surgery. Coronary angiography showed extensive coronary atherosclerosis with patent vein grafts to his diagonal branch and right coronary arteries. There was a severe narrowing lesion in the left subclavian artery before the origin of the left internal mammary artery (LIMA), which appeared patent. Percutaneous subclavian angioplasty and stent implantation to the left subclavian artery stenosis restored normal flow to the left hand and the LIMA with abolition of his ischemic hand symptom and marked improvement of his angina. (+info)