Carotid-Subclavian Bypass with or without Carotid Endarterectomy

From 1981 to 1987, 29 patients (14 women and 15 men, with a mean age of 56 +/- 15 years) underwent a carotid-subclavian bypass for occlusive lesion of the subclavian artery (or of the left common carotid artery). The symptomatology included vertebrobasilar insufficiency, arm ischemic symptoms, or combination of both symptoms. Twelve patients (42%) have had a previous transient ischemic attack, or a cerebrovascular accident. There were 22 stenoses or occlusions of the left subclavian artery, and 6 of the right subclavian artery. On arteriography, 9 patients had significant associated lesions on the internal carotid artery, either homolateral (n = 7), or heterolateral, or bilateral. Carotid to subclavian bypasses were performed either with autogenous saphenous vein (n = 15), or with prosthetic graft (n = 14). In 5 cases, a carotid endarterectomy was done simultaneously to the bypass. Operative mortality was 3.4% (1/29). Early patency (less than 1 month) was 97% and late patency 89%, with a mean follow-up of 40 +/- 24 months. The patency rates were not significantly different whether a prosthesis or a vein was used for the bypass. All patients were improved and complete relief of symptoms was achieved in 92%. No patient experienced symptoms of carotid steal after the bypass. We concluded that carotid-subclavian bypass is a safe and efficient method for revascularization of the subclavian artery of of the left common carotid artery in selected cases.