The Turkish Journal of Vascular Surgery
Yazarlar: Aslıhan KÜÇÜKER, Mete HIDIROĞLU, Levent ÇETİN, Ayşegül KUNT, Fethi SAĞLAM, Hüseyin BAYRAM, Abdülkadir BİLGİÇ, Ünsal ERÇELİK, Murat CANYİĞİT, Tülin GÜMÜŞ, Erol ŞENER
Konular:-
Anahtar Kelimeler:Carotico-subclavian bypass; subclavian steal syndrome; vertebrobasilar insufficiency
Özet: Objective: We present our patients who underwent carotico-subclavian bypass operation either for subclavian steal syndrome or for subclavian artery revascularization prior to thoracic endovascular aneursym repair procedures. Material and Methods: We performed 16 carotico-subclavian bypass operations between August 2009-November 2013 in our department. Nine patients were operated for subclavian steal syn- drome with subclavian artery occlusion and 7 patients were operated before thoracic endovascular stent graft- ing for type III aortic dissection or the thoracic aneursym necessitating left subclavian artery occlusion. Fourteen male (87.5%) and 2 female (12.5%) patients with their ages ranging between 55-74 (mean 66.3) years were operated. All operations were performed under general anesthesia with a supraclavicular incision. In 14 patients, 8-mm Dacron grafts were used and in 2 patients 8 mm polytetrafluoroethylene grafts were used. Anastomoses were done in end-to-side fashion. Results: Radial artery pulses were palpable in all the patients after the operation, and their complaints like left arm pain or dizziness were resolved. Early 30-day morbid- ity was 6.2 % with one patient experiencing puffiness and pain at the left shoulder two weeks after the operation, due to seroma which was drained percutaneously under ultrasonography guidance after diagnosis. No perioperative stroke or minor cerebrovascular events were observed. One patient who had a native carotid ar- tery tortuosity and cerebral artery aneurysm suffered from carotid-subclavian bypass graft thrombosis 2 days after the operation, with an early graft thrombosis rate of 6.2 %. No carotid-subclavian procedure related mor- talities were observed. Patients to have thoracic endovascular aortic repair (TEVAR) procedures with a re- quirement of intentional left subclavian artery (LSA) coverage were primarily operated for carotico-subclavian graft interposition to provide LSA revascularization, and subsequently TEVAR procedure was performed. Conclusion: Carotico-subclavian bypass is a safe procedure with good surgical results.