Subclavian-carotid transposition. Experience in 33 cases.

Thirty-three patients with a lesion of the proximal subclavian artery are treated by transposition of this endarterectomised vessel into the common carotid artery. The main advantages of this technique are the short operative time, the extra-thoracic approach, the absence of prosthetic material and the construction of an hemodynamic favorable anastomosis. There was a low morbidity and zero mortality in this series. All patients were selected by careful extensive continuous wave ultrasound Doppler examination of the extracranial arteries. Angiography is only required in case of an unclear Doppler finding, a multivessel extracranial or a peripheral arterial disease and in case of a redo-subclavian surgery. Good results of the technique can only be guaranteed if the donor arterial system is free of hemodynamically significant lesions. If not so, these lesions should be repaired first. Vertebral blood-flow is normalized in 97% of the patients (32/33 patients). Because of the excellent hemodynamic and clinical results, the subclavian artery transposition is the method of choice in the operative treatment of the proximal subclavian lesions.