Operative correction of proximal blocks of the subclavian or innominate arteries.

Ninety-four operations were performed on 90 individuals with occlusive disease of the subclavian or innominate arteries during the past 17 years. The left subclavian was occluded in 71, the right in 10, and the innominate in 9. Presenting symptomatology was neurological in 34, arm ischemia in 30 and combined in 26. Blood pressure was reduced by 30 mmHg on the involved side in all. An extrathoracic approach was used in 78 and a transthoracic approach in 16. Early mortality 18.7% and morbidity 18.7% was associated with the transthoracic approach. Long subcutaneous axillo-axillary and axillo-carotid are prone to thrombosis and skin erosion. Carotid-subclavian grafts used in 64 remain patent, occasionally become infected (4.7%), are associated with a low mortality and do not develop "carotid steal". When associated with vascular insufficiency of the lower extremity (44%) the brachiocephalic lesion should be corrected first.