Simplified operative procedure for proximal subclavian arterial lesions: direct subclavian-carotid anastomosis.

An operative approach to treatment of proximal subclavian occlusive lesions was used in 11 patients with claudication of the arm, vertebrobasilar insufficiency or subclavian steal syndrome. Through a supraclavicular incision, the subclavian artery is isolated proximal to the vertebral origin, dissected from the periarterial tissue into the mediastinum and then clamped above the atherosclerotic lesion. The artery is transected and the proximal end closed. The distal portion of the subclavian is then anastomosed end-to-side to the common carotid either in front of or behind the internal jugular vein. This procedure, applicable to right or left subclavian occlusive or ulcerative lesions, is particularly advantageous since it avoids major thoracotomy and the use of prosthetic bypasses in the neck. Postoperative noninvasive and angiographic evaluation in this series of patients indicates that the technique is simple, effective and without complications, making it preferable to existing procedures.