Axillo-axillary Graft Research Articles

The Long-term Outcome after Axillo-axillary Bypass Grafting for Proximal Subclavian Artery Disease

Objectives to investigate the outcome of patients undergoing axillo-axillary bypass grafting for symptomatic subclavian artery stenoses or occlusions. Design retrospective case-note review and prospective review of patients available for follow-up. Patients and methods sixteen patients had axillo-axillary grafts in a 17-year period. Ten patients were available for review and assessed clinically, by measurement of arm blood pressures, and by duplex scanning of their grafts. Results one patient died and three grafts occluded within 30 days of operation. Nine out of 10 grafts scanned were patent, with three further grafts clinically patent at death. Overall secondary patency was 75% at a combined median follow-up of 56 months (range 12–204 months). Recurrent symptoms occurred in two patients, one with an occluded graft and one with a patent graft. Conclusion axillo-axillary bypass grafts give good long-term symptom-free results.

Long-term results with axillo-axillary bypass grafts for symptomatic subclavian artery insufficiency.

The surgical treatment for patients with a subclavian steal is controversial, especially for patients with coexisting severe carotid stenosis. This study determines the long-term efficacy of axillo-axillary bypass grafts in patients with and without a simultaneous carotid endarterectomy. The axillo-axillary bypass was done in 39 patients who were monitored for 5.8 +/- 3.9 years. Fifteen of these patients with severe carotid artery disease had a carotid endarterectomy done simultaneously. Twenty-four patients had an axillo-axillary bypass alone; four of these patients later had a carotid endarterectomy at 0.5 to 10 years. Graft patency was evaluated at intervals of 6 to 12 months by clinical evaluation and noninvasive vascular studies. Ten-year primary and secondary patency rates for all axillo-axillary bypass grafts were 88% and 91%, respectively. When carotid endarterectomy was done with axillo-axillary bypass, these patency rates were 86% and 93%, respectively. Patients with only axillo-axillary grafts had 10-year primary and secondary patency rates of 89% and 89%, respectively. Most patients had complete relief from symptoms of arm ischemia (90%) and vertebrobasilar insufficiency (85%). No perioperative mortality or permanent neurologic deficit occurred. Axillo-axillary bypass is a safe and effective method for revascularization of the subclavian artery and should be considered for patients at high risk.