Extrathoracic approach for reconstruction of subclavian and vertebral arteries.

One hundred extrathoracic arterial reconstructions were performed on 98 patients with occlusions or stenoses of the subclavian or vertebral arteries: 52 bypasses, 18 transpositions of the subclavian artery to the common carotid artery, 13 endarterectomies and 17 operations involving two or more simultaneous reconstructions. The operative mortality was 1% (one patient). In 2 patients hemiplegia occurred as a complication of carotid-subclavian bypass operation. Six patients had a nerve injury as an operative complication: 1 lesion of the brachial plexus, 3 lesions of the recurrent nerve, and two lesions of the phrenic nerve (one patient also had Horner's syndrome). Immediate thrombosis of the operated arteries developed in 7 patients, 2 of whom were re-operated on. During the follow-up period (mean 4.5 years), six additional operations were performed because of failure of the first operation: the bypass graft was thrombosed in 5 of these cases and in one case a venous bypass graft with insufficient flow was replaced by a prosthesis. One patient underwent reconstruction of the contralateral side because of residual symptoms. In addition, 1 carotid endarterectomy, 2 thoracic sympathectomies, 4 coronary artery reconstructions and 8 lower limb arterial reconstructions were performed during the follow-up period. There were 17 late deaths, 9 of which were due to coronary artery disease. Of the 80 survivors 79% were satisfied with the operative result. The bypass was considered patent in 68%.