Comparison of extra-anatomic bypass grafting with angioplasty for atherosclerotic disease of the supra-aortic trunks

• Published in: British journal of surgery 2004-11, Vol.91 (11), p.1453-1457
• Main Authors: Modarai, B., Ali, T., Dourado, R., Reidy, J. F., Taylor, P. R., Burnand, K. G.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Angioplasty - methods; Aortic Diseases - surgery; Arm - blood supply; Arteriosclerosis - surgery; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis Implantation - methods; Cardiology. Vascular system; Female; Follow-Up Studies; General aspects; Humans; Ischemia - etiology; Male; Medical sciences; Middle Aged; Prospective Studies; Stents; Subclavian Steal Syndrome - surgery
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.4751

Background: Symptomatic stenosis of the supra‐aortic trunks (subclavian, innominate and common carotid arteries) can be treated by angioplasty/stenting or surgical bypass. The aim of this study was to compare the initial success and outcome of these two types of treatment. Methods: A prospective database was used to collect information on the presentation, initial success, complications and outcome in 76 patients treated in a single centre between 1983 and 2003. Results: Thirty‐five surgical extra‐anatomic bypasses were performed, 13 carotid to carotid, 14 carotid to subclavian, two carotid to axillary, three axillary to axillary, one subclavian to axillary and two subclavian to subclavian. One graft occluded after 19 years. No limbs were amputated and no patient had a stroke. The secondary patency rate was 97 per cent at a mean follow‐up of 5 years. Forty‐one angioplasties were attempted, 34 of the left subclavian, six of the right subclavian and one of the innominate artery. Angioplasty for six subclavian occlusions was unsuccessful. Twenty‐seven of 33 arteries remained patent at a mean follow‐up of 4 years after a successful endovascular procedure. Conclusion: Extra‐anatomic bypass for supra‐aortic trunk disease has a better patency than angioplasty, with a comparable complication rate. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Still a role for surgery?