The surgical treatment of atherosclerotic occlusion of the innominate and subclavian arteries. Personal experience with longterm follow-up.

Among 78 patients operated on for occlusive disease of the supraaortic trunks in the period 1970-78, 34 patients who underwent carotid-subclavian bypass (64.7%), aortocarotid bypass (17.6%), endarterectomy of subclavian artery (5.8%) or endarterectomy of innominate artery, had follow-up studies of 3-10 years after surgery. All patients demonstrated originally a differential in systolic blood pressure in the upper extremities. The surgical indications were posed on the basis of neurologic symptoms of vertebrobasilar insufficiency and the angiographic evidence of "subclavian" (79.4%) or "innominate" (20.6%) steal. Carotid-subclavian bypass has been the preferred surgical treatment technique in patients with "subclavian steal". This operation is indicated also in nearly asymptomatic patients in order to prevent the natural history of vertebrobasilar insufficiency. In our experience, operative risk in carotid-subclavian bypass is not present, unless an associated lesion of carotid bifurcation exists, which needs an endarterectomy with patch-graft angioplasty. Longterm results are considered satisfactory in surgically treated patients.