OBJECTIVE
To compare in-hospital and long-term results of carotid-subclavian bypass grafting and subclavian-carotid transposition in patients with subclavian artery occlusion and steel syndrome.
MATERIAL AND METHODS
Cohort comparative retrospective open study included 182 patients with subclavian artery for the period from January 2010 and March 2020. Depending on surgical correction, all patients were divided into 2 groups: group 1 (n=95) — carotid-subclavian bypass grafting; group 2 (n=87) — subclavian-carotid transposition. Vascutek prosthesis was used in the first group. In this group, mean follow-up period was 79.8±34.5 months; in group 2 — 83.0±25.1 months. The endpoints of the study were adverse cardiovascular events such as death, myocardial infarction (MI), stroke/transient ischemic attack, thrombosis/restenosis of anastomosis/prosthesis, combined endpoint (death from stroke/transient ischemic attack + MI + stroke/transient ischemic attack).
RESULTS
No in-hospital cardiovascular complications were obtained. In few cases, paresis of the larynx with clinical regression at discharge and chylothorax were observed in both groups. Lymphorrhea was more common after carotid-subclavian bypass grafting (9 (9.5%) vs. 1 (1.1%); p=0.03; OR 9.0; 95% CI 1.11—72.62). Long-term outcomes were comparable in both groups. Carotid-subclavian bypass grafting was followed by higher number of thrombosis of prosthesis/reconstruction zone (5 (5.5%) vs. 0; p=0.08; OR 10.64; 95% CI 0.57—195.4), restenosis (8 (8.4%) vs. 3 (3.4%); p=0.27; OR 2.57; 95% CI 1.11—72.62 ). There was 1 case of prosthetic infection in the same group (p=0.96; OR 2.77; 95% CI 0.11—69.15).
CONCLUSION
Both revascularization techniques are characterized by similar in-hospital efficacy and safety. However, carotid-subclavian bypass grafting was followed by higher incidence of early postoperative lymphorrhea, graft dysfunction with associated ischemic complications in long-term follow-up period and higher risk of infectious complications with sepsis and bleeding. Considering these data, carotid-subclavian bypass grafting is less preferable for subclavian artery occlusion and steel syndrome.
