Occlusive disease of the common carotid and subclavian arteries treated by carotid-subclavian bypass

Abstract Carotid-subclavian bypass has been employed in the treatment of cerebrovascular insufficiency, upper extremity claudication, or a combination of these syndromes in 125 patients. All patients were studied angiographically prior to operation with either bilateral carotid and subclavian puncture or retrograde aortic arch injection. Indications for carotid subclavian bypass operation included: upper extremity claudication, twenty-one cases; symptoms of vertebrobasilar insufficiency, forty-nine cases; upper extremity claudication combined with symptoms of vertebrobasilar insufficiency, subclavian steal syndrome, and brachial-basilar insufficiency syndrome, thirty cases; symptoms of cerebrovascular insufficiency due to an obstructing lesion at the origin of the carotid arteries, twentyfive cases. Left carotid-subclavian bypass was employed in ninety-one patients (72 per cent) and right carotid -subclavian bypass in twenty (16 per cent). In fourteen patients (11 per cent) thromboendarterectomy of the common carotid bifurcation accompanied the carotid-subclavian bypass. There was an operative mortality of 4.8 per cent in this series of 125 patients. Follow-up studies obtained on all patients extending from nine months to fourteen years have demonstrated the effectiveness of this method of operative treatment.