Immediate Results of Open Surgery for Subclavian Artery Atherosclerotic Lesions Treatment Complicated by Internal Carotid Artery Stenosis

Methods: 104 patients with atherosclerotic subclavian artery stenosis received surgical treatment in the Centre of Cardiac and Vascular Surgery of the Chelyabinsk Region Hospital from March 2007 till December 2012. 30 of them were diagnosed with a significant ipsilateral carotid artery stenosis. Patients were divided into two groups. A simultaneous subclavian and carotid artery surgery was performed on the first group of 29 patients. 75 patients from the second group had only an isolated subclavian artery plastic surgery .In the first group several types of operations were performed : the subclavian carotid transposition (SCT) with concomitant carotid endarterectomy (CEA) in 13 of cases; carotid subclavian bypass grafting (CSB) with concomitant CEA in 16 cases. 39 CSTs and 36 CSBs were performed in the second group. Statistic analysis was performed with STATISTICA 6.0 and Microsoft Excel 5.0 Results: There were no deaths or myocardial infarction in the first group. One patient had an ipsilateral ischemic stroke (2,9%), and another one had a contralateral ischemic stroke (2,9%). In the second group there were no strokes or deaths. In one case the myocardial infarction occurred (2,5%) on the second day of the postoperative period. There were no significant differences between groups (P>0,05). Conclusion: concomitant carotid and subclavian surgery is a safe, feasible and effective method of treatment and could be recommended in such groups of patients. For patients with a significant contralateral subclavian and carotid  stenosis the staged strategy should be chosen with performing CEA as the first step. In our opinion, the subclavian carotid transposition is the method of choice in subclavian artery surgery with good immediate and long term results. Key words: carotid artery, subclavian artery, carotid endarterectomy, subclavian carotid transposition, carotid subclavian bypass grafting.