[Subclavian-carotid transposition--experience in the treatment of arteriosclerotic lesions of the carotid artery near its origin].

Symptomatic atherosclerotic lesions of the subclavian artery are rare. A special treatment is necessary and consists today of various extrathoracic bypass procedures or a subclavian-carotid-transposition. The latter is our preferred kind of therapy. 116 patients (57 female, 59 male, mean age 59.1 years, 116 operations) underwent subclavian-carotid-transposition for symptomatic subclavian artery lesion of the first segment. In 33.6% a thrombendarterectomy of the ipsilateral carotid bifurcation and in 19% an open or eversion thrombendarterectomy of the second segment of the subclavian artery and/or the vertebral artery had to be performed. 3 patients (2.6%) died perioperatively (myocardial infarction 2, cerebral infarction 1). In 3 out of 4 early postop, thrombosed transpositions patency was restored successfully. 70 patients (74.5% of the patients alive) were followed for in the mean 58.6 +/- 41.5 months. The transposition was found to be patent in 67 (95.7%) patients, a mild stenosis presented 2, an occlusion 1 (occluded perioperatively). The cumulative patency rate (126 months) was 95%. Subclavian-carotid transposition is in contrast to bypass procedures a more difficile treatment for symptomatic subclavian lesions with various advantages. Besides an orthograde inflow to subclavian and vertebral artery and the construction of simply one anastomosis with wall segments of identical compliance the main advantage is the avoidance of any autogenous or artificial bypass material. Excellent long-term results underline that this therapy is the more elegant and better concept treating subclavian artery lesions of the first segment.