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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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Accepted: November 20, 1973
© 1974 Published by Elsevier Inc.