[Surgical treatment of subclavian artery occlusion].

OBJECTIVE

To explore the effective surgical approaches in treating subclavian artery occlusion.

METHODS

Between December 2005 and February 2010, 53 patients with subclavian artery occlusion were treated, including left subclavian artery occlusion (35 cases) and stenosis (5 cases), right subclavian artery occlusion (5 cases) and stenosis (4 cases), and bilateral subclavian artery occlusion (4 cases). There were 40 males and 13 females with an average age of 64 years (range, 22-77 years), including 49 cases of arteriosclerosis obliterans and 4 cases of aortic arteritis. The disease duration was 15 days to 20 months (6.5 months on average). In 49 patients with unilateral subclavian artery occlusion, 39 cases complicated by carotid or/ and cerebral artery lesion underwent axillo-axillary bypass grafting, and 10 cases without carotid or/and cerebral artery lesion underwent carotid-subclavian bypass grafting. Ascending aorta to bi-subclavian bypass grafting were performed on 4 cases with bilateral subclavian artery occlusion. After operation, patients received routine treatment with anticoagulant and antiplatelet agents.

RESULTS

The operations were successfully performed in 52 cases with a successful rate of 98.11%. Thrombogenesis at anastomotic site occurred in 1 case of aortic arteritis after 48 hours. Two cases had brachial plexus crush injury and 4 had hematoma around the bilateral anastomosis after axillo-axillary bypass grafting, and all recovered with nonoperative therapy. A total of 52 patients were followed up 1-52 months (24.5 months on average). All patients survived and the symptoms of basilar and upper limb artery ischemia disappeared. Doppler ultrasonography showed that the blood flow was patent through anastomosis and polytetrafluoroethylene graft, and the vertebral artery flow was normal. Pseudoaneurysm at anastomosis was found in 1 case after 18 months and treated by interventional embolization. The postoperative graft patency rate was 100% at 1 year and at 2 years.

CONCLUSION

Both thoracic and extrathoracic surgical approaches are effective for treating subclavian artery occlusion. The reasonable surgical approach should be selected according to the arteriopathy and the patient's condition. Perioperative treatment and strict intraoperative manipulation are important to guarantee the success of surgery.