Extrathoracic bypass of an orifice occlusive lesion in the arch vessels: case reports and literature review.

Arterial occlusive disease of the arch vessels is often associated with flow reversal in the vertebral artery of such patients, the so-called subclavian steal syndrome. We treated two such cases that were diagnosed based on symptoms, physical examination and angiography. In the first case, the occlusive lesion was found at the origin of left subclavian artery, while the occlusion was positioned at the origin of innominate artery in the second case. A carotid-subclavian and a carotid-carotid bypass using 8-mm PTFE grafts were performed, respectively. No complications were noted and the patients have retained a symptom-free status during a follow-up of 5 years. Taking into account the expense of stenting and the patency rate, extrathoracic bypass surgery using a PTFE graft for the treatment of orifice occlusive lesions of arch vessels is cheaper and has an overall better patency rate. Furthermore, because it is the final choice of treatment after percutaneous transluminal angioplasty fails, it should be considered as an ideal therapy for lesions at the origin of arch vessels.