Subclavian artery reconstruction in patients undergoing coronary artery bypass grafting.

The presence of occlusive disease of the subclavian artery (SCA) proximal to the origin of the internal thoracic artery (ITA) influences the operative strategy and the outcome of coronary artery bypass grafting (CABG). Of 780 patients who underwent CABG, concomitant SCA occlusive lesions were reconstructed in 13 patients (nine males, four females). The affected SCAs were left-sided in 11 patients, and right-sided and bilateral in one, each. An aortoaxillary bypass utilizing an 8-mm PTFE graft was constructed in nine patients and a carotid-subclavian (C-S) transposition in two, simultaneously with CABG. Percutaneous balloon angioplasty with a stent was performed in two patients prior to CABG. With follow-up periods ranging from 4 to 8.4 years (mean, 6.3 years), aortoaxillary bypass grafts were patent in all patients. Other reconstructive procedures, including a C-S transposition and balloon angioplasty, were performed safely and effectively in off-pump CABG patients. In six patients, the left internal thoracic artery (LITA) could be used as a graft to the coronary artery after SCA reconstruction. Aortoaxillary bypass using an 8-mm PTFE graft is a safe and effective way for simultaneous subclavian reconstruction in patients undergoing CABG. Mid-term patency of the graft is satisfactory. The LITA can be used as a graft to the coronary arteries in selected patients. Preoperative brachial angiography is mandatory in these patients.