The superiority of synthetic arterial grafts over autologous veins in carotid-subclavian bypass

Abstract

From May 1964 to June 1983, 36 carotid-subclavian bypasses were done in 36 patients who had symptomatic lesions at the origin of the common carotid and/or subclavian arteries at the Center for Health Sciences of the University of California, Los Angeles. Ages ranged from 28 to 82 years (mean, 58 years). Eighteen bypasses were done with prosthetic grafts, 13 done with autogenous vein, and five were transpositions with primary anastomosis of the subclavian and carotid arteries. Follow-up was available on all patients and ranged from 9 to 156 months (mean, 51.5 months). The graft patency rate at 5 years determined by actuarial methods and documented by clinical examination, noninvasive evaluation, and/or arteriography was 94.1% for prosthetic grafts and 58.3% for vein grafts (p less than 0.01). The 5-year cerebrovascular accident (CVA) rate for patients with carotid-subclavian bypass done with prosthetic grafts was 6% in contrast to 39% for those with vein grafts (p less than 0.0545). All reconstructions done by transposition and primary anastomosis remain patent and there have been no late CVAs. We conclude that prosthetic grafts are the arterial substitute of choice in carotid-subclavian bypass. Transposition and primary anastomosis between the carotid and subclavian artery, when technically feasible, may be preferable to the use of free grafts in carotid-subclavian reconstruction.

Angioplasty and Stenting versus Carotid-Subclavian Bypass for the Treatment of Isolated Subclavian Artery Disease

“…Extra-anatomical bypass, namely CSBG, and carotid-subclavian transposition, were proposed as alternatives, which offered similar patency rates with reduced morbidity and mortality. [14][15][16][17][18][19][20][21][22] Carotid-subclavian transposition was touted to eliminate the need for ¤ ¤ prosthetic material in the neck. Infection rates are invariably low in this operation, and the decision to perform CSBG versus carotidsubclavian transposition has been predominantly based on surgeon preference.…”

Current status of prosthetic bypass grafts: A review

“…They found that 20% of autologous vein grafts underwent stenosis compared to 5% among the ePTFE grafts 85. In an earlier study involving carotid–subclavian bypasses, 94% of ePTFE grafts were patent at 5 years compared to 58% for autologous veins ( p < 0.01) 86. All these results suggest that ePTFE grafts are comparable if not better than autologous vein grafting.…”

Durability of Autogenous Vein and Polytetrafluoroethylene Bypass Grafts to the Carotid Arteries

“…On this basis, we consider that grafts with larger diameters may be preferable. Vein has been the preferred conduit in many studies; however, Rockman et al 7 and Ziomek et al 10 showed a higher graft failure rate when using vein compared with PTFE for CAB. Also, Lauder et al reported a comparatively poor 83% freedom from re‐stenosis rate at 2 years in a series of 50 vein graft CAB, with most graft failures occurring within the first 9 months 16 .…”

“…Carotid artery bypass using autogenous or synthetic conduits has previously been reported with assisted primary patency rates of 87–100% being achieved at 5 years 2,4–6,10 . Five‐year freedom from stroke at 92% is also high and compares favourably with the results of CEA 5 …”