Cerebral revascularization by axillary-carotid bypass.

Revascularization for symptomatic proximal common carotid severe stenosis or occlusion frequently requires a bypass procedure. Subclavian-carotid bypass is probably the most frequently performed operation. In the past 5 years 13 patients underwent an alternative operation, axillary-carotid bypass, which may be technically easier than subclavian-carotid bypass and just as durable. The graft is placed under the clavicle, in an easily constructed tunnel not involving the true thoracic outlet, deep to the sternocleidomastoid muscle and internal jugular vein. Five distal anastomoses were made to the common carotid (2 greater saphenous vein, 2 Dacron and 1 Gortex grafts), 4 to the internal carotid (all vein) and 4 to the external carotid (all vein, 1 sequential with a end-side anastomosis to the ipsilateral vertebral). There were no perioperative deaths. One stroke occurred in a patient with a Dacron graft to the common carotid who also had a concomitant ipsilateral carotid endarterectomy. All grafts were open by Doppler exam at a mean follow-up of 2 1/2 years. Improved cerebral hemodynamics was confirmed in 11 patients by Gee oculoplethysmography. These early results support the use of the axillary artery as a donor for extracranial cerebral revascularization when the proximal common carotid is occluded or severely stenotic.