The early and midterm results of carotid-subclavian and subclavian-subclavian bypass in the treatment of subclavian steal syndrome

Background: In this study, the early and midterm primary graft patency and clinical outcomes of carotid-subclavian bypass (CSB) and subclavian-subclavian bypass (SSB) in the surgical treatment of proximal subclavian artery disease were compared. Methods: Between April 199 and June 2011, 32 patients who underwent SSB and CSB surgery were retrospectively analyzed. Surgical treatment was performed by using CSB procedures on 17 of the patients (9 males, 8 females; mean age 55.4 +/- 13.3 years; range 38 to 75 years) and by using SSB procedures on 15 (10 males, 5 females; mean age 51.6 +/- 13.6 years; range 21 to 69 years). Four patients who were performed CSB and three patients who were performed SSB had previously undergone coronary artery bypass grafting (CABG) surgery. Primary graft patency was assessed by color Doppler ultrasonography, physical examination, and by angiography, where appropriate. Statistical analyses were performed using Fischer's exact test, Chi-square, Student t test and Mann-Whitney U tests. The cumulative primary graft patency was evaluated by using Kaplan Meier life table. Results: In both types of surgery, early period (the first 30 days after surgery) primary graft patency was 100%, indicating no statistical difference (p>0.05). The primary patency rates in the SSB group were 78.5% at one, 61.5% at three and 53.8% at five years. The primary patency rates in the CSB group were 100% at 1, 3 and 5 years (respectively at 1,3 and 5 years; p<0.05, p<0.01, p<0.01). Early mortality in the SSB group were 6.7% (n=1) and in the CSB group were 5.9% (n=1), indicating no significant difference. Midterm mortality in the SSB group were 7.1% (n=1) and in the CSB group 0%, indicating no significant difference (p>0.05). Conclusion: Our study showed that better results were obtained with CSB considering the primary graft patency and clinical outcomes. We believe that CSB may be preferred as a more effective, safe and easily applicable method for appropriate patient profile.