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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 1998 December;39(6):729-34

lingua: Inglese

Surgical treat­ment of ath­e­ros­cle­rot­ic ­lesions of sub­cla­vian ­artery: carotid-sub­cla­vian ­bypass ver­sus sub­cla­vian-carot­id trans­po­si­tion

Deriu G. P., Milite D., Verlato F.*, Cognolato D., Frigatti P., Zaramella M., Mellone G., Greco F.

From the Chair of Vascular Surgery, Padua Medical School, Italy
* Angiology Department, Hospital of Padua, Padua, Italy


Background. The aim of ­this ret­ro­spec­tive ­study is to ana­lyze the ­short and ­long ­term ­results of two dif­fer­ent sur­gi­cal treat­ments in ­patients ­with sub­cla­vian ­lesions: com­mon carot­id-sub­cla­vian ­artery ­bypass (CSB) ver­sus trans­po­si­tion of sub­cla­vian ­artery on the com­mon carot­id ­artery (SCT).
Methods. From 1981 ­until 1995, 40 non ran­dom­ized ­patients ­with symp­to­mat­ic sub­cla­vian ­steal under­went 20 CSBs and 20 SCTs. Risk fac­tor ­rates ­were equal­ly bal­anced in the two ­groups. Surgery was car­ried out rou­tine­ly ­under gen­er­al anes­the­sia, ­with elec­tro­en­ce­phal­ic con­tin­u­ous mon­i­tor­ing. Patency of revas­cu­lar­iza­tion was ­assessed by phys­i­cal exam­ina­tion, bra­chi­al ­blood pres­sure deter­mi­na­tions, ultra­sound sonog­ra­phy and angio­gra­phy when­ev­er recur­rence of symp­toms devel­oped or ­when the func­tion of ­repair was in ­doubt. Patients ­were exam­ined eve­ry ­year. In Spring 1996 (­range 9-189 mos, aver­age 7 ­years) a gen­er­al clin­i­cal-instru­men­tal fol­low-up was per­formed.
Results. In the ­short ­term (<30 ­days) mor­tal­ity was 5%: one ­death (5%) for pul­mo­nary embo­lism in a ­patient ­with CSB and one for myo­car­dial infarc­tion in a ­patient ­with SCT. The ear­ly throm­bo­sis ­rate was 5% (1 CSB and 1 com­mon carot­id ­artery dis­tal to a pat­ent SCT). During fol­low-up 10 ­patients (25%) ­died and 6 ­were ­lost. The six-­year actu­ar­i­al paten­cy ­rate was 100% for SCT and 66% for CSB. Moreover ­there ­were 3 throm­bos­es of the ver­te­bral ­artery homo­lat­er­al to pat­ent CSBs.
Conclusions. In con­clu­sions SCT ­should be con­sid­ered the sur­gi­cal tech­ni­cal ­choice for the treat­ment of prox­i­mal sub­cla­vian ­artery ­lesions.

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