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Abstract
A simple cross-axillary artery bypass is being proposed as therapy for the subclavian
steal syndrome. In subclavian artery occlusion, blood flows retrogradely through the
vertebral artery to supply blood to the arm, thus stealing blood from the head and
causing brain ischemia. The problem is to supply blood to the arm and subclavian artery
with sufficient pressure to profuse the arm and, in addition, provide prograde flow
in the vertebral artery. A vein graft or prosthesis is attached to the good axillary
artery and brought across the chest to the contralateral side. The second and third
parts of the axillary artery are exposed at the shoulder. The bypass is anastomosed
to the third part of the axillary artery on each side. The graft is pulled through
a split in the pectoralis major muscle and through a subcutaneous tunnel created on
the chest wall to the opposite side. Operations performed in the neck and behind the
clavicle utilize the good ipsolateral carotid artery as the source of blood for revascularization
of vertebral or subclavian artery. Intrathoracic operations may be of more serious
consequence than the disease. Even the clavicle-splitting operations are of appreciable
magnitude and produce prolonged disability. Utilization of the good carotid artery
imposes the added risk of serious brain ischemia during surgery and postoperatively.
The simplicity of the procedure and the excellent long-term clinical result obtained
with axillary-to-axillary artery bypass makes it the procedure of choice.
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Article info
Publication history
Accepted:
November 20,
1973
Identification
Copyright
© 1974 Published by Elsevier Inc.
