Subclavian revascularization

A quarter century experience

William H. Edwards, S. Scott Tapper, William Edwards, Joseph L. Mulherin, Raymond S. Martin, Judith M. Jenkins

    Research output: Contribution to journalArticle

    62 Citations (Scopus)

    Abstract

    Objective: Twenty-five years of experience with subclavian revascularizations were reviewed to determine the long-term patency rates of different extrathoracic approaches. Summary Background Data: Although it is generally agreed that proximal subclavian stenosis should be treated by an extrathoracic route whenever possible, the optimum procedure is debated. Alternatives include subclavian carotid bypass, subclavian-to-subclavian or axilloaxillary bypasses, and the authors' preferred technique of subclavian carotid transposition (SCT). Methods: Records were researched for the past 25 years in a single specially surgical clinic for extrathoracic subclavian revascularizations. One hundred ninety such procedures were identified, and hospital charts and office medical records were reviewed for procedure, preoperative symptoms, blood pressure differentials, and postoperative complications. Patency was determined by physical examination, differential blood pressures, Doppler spectral analysis, duplex examinations, and arteriography. Results: Bypass procedures were used infrequently, and although the results are reported, they are excluded from any analysis. Subclavian carotid transposition was used in 178 procedures. All anastomoses were found to be patent at follow-up, except for one, which failed at 26 months. Mean follow-up was 46 months, with five patients lost to follow-up. Overall mortality rate was 2.2%, with the mortality falling to 1.1% if only subclavian carotid transposition patients are included. Conclusions: Subclavian carotid transposition should be the treatment of choice for routine subclavian carotid occlusive disease because of its exceptional long- term patency and low morbidity.

    Original languageEnglish (US)
    Pages (from-to)673-678
    Number of pages6
    JournalAnnals of surgery
    Volume219
    Issue number6
    DOIs
    StatePublished - Jan 1 1994

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    Blood Pressure
    Preoperative Care
    Mortality
    Lost to Follow-Up
    Physical Examination
    Medical Records
    Angiography
    Pathologic Constriction
    Morbidity
    Therapeutics

    All Science Journal Classification (ASJC) codes

    • Surgery

    Cite this

    Edwards, W. H., Tapper, S. S., Edwards, W., Mulherin, J. L., Martin, R. S., & Jenkins, J. M. (1994). Subclavian revascularization: A quarter century experience. Annals of surgery, 219(6), 673-678. https://doi.org/10.1097/00000658-199406000-00010

    Subclavian revascularization : A quarter century experience. / Edwards, William H.; Tapper, S. Scott; Edwards, William; Mulherin, Joseph L.; Martin, Raymond S.; Jenkins, Judith M.

    In: Annals of surgery, Vol. 219, No. 6, 01.01.1994, p. 673-678.

    Research output: Contribution to journalArticle

    Edwards, WH, Tapper, SS, Edwards, W, Mulherin, JL, Martin, RS & Jenkins, JM 1994, 'Subclavian revascularization: A quarter century experience', Annals of surgery, vol. 219, no. 6, pp. 673-678. https://doi.org/10.1097/00000658-199406000-00010
    Edwards WH, Tapper SS, Edwards W, Mulherin JL, Martin RS, Jenkins JM. Subclavian revascularization: A quarter century experience. Annals of surgery. 1994 Jan 1;219(6):673-678. https://doi.org/10.1097/00000658-199406000-00010
    Edwards, William H. ; Tapper, S. Scott ; Edwards, William ; Mulherin, Joseph L. ; Martin, Raymond S. ; Jenkins, Judith M. / Subclavian revascularization : A quarter century experience. In: Annals of surgery. 1994 ; Vol. 219, No. 6. pp. 673-678.
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    abstract = "Objective: Twenty-five years of experience with subclavian revascularizations were reviewed to determine the long-term patency rates of different extrathoracic approaches. Summary Background Data: Although it is generally agreed that proximal subclavian stenosis should be treated by an extrathoracic route whenever possible, the optimum procedure is debated. Alternatives include subclavian carotid bypass, subclavian-to-subclavian or axilloaxillary bypasses, and the authors' preferred technique of subclavian carotid transposition (SCT). Methods: Records were researched for the past 25 years in a single specially surgical clinic for extrathoracic subclavian revascularizations. One hundred ninety such procedures were identified, and hospital charts and office medical records were reviewed for procedure, preoperative symptoms, blood pressure differentials, and postoperative complications. Patency was determined by physical examination, differential blood pressures, Doppler spectral analysis, duplex examinations, and arteriography. Results: Bypass procedures were used infrequently, and although the results are reported, they are excluded from any analysis. Subclavian carotid transposition was used in 178 procedures. All anastomoses were found to be patent at follow-up, except for one, which failed at 26 months. Mean follow-up was 46 months, with five patients lost to follow-up. Overall mortality rate was 2.2{\%}, with the mortality falling to 1.1{\%} if only subclavian carotid transposition patients are included. Conclusions: Subclavian carotid transposition should be the treatment of choice for routine subclavian carotid occlusive disease because of its exceptional long- term patency and low morbidity.",
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