Subklavyan Arter Darlıklarında Cerrahi Uygulamalar ve Sonuçları

Objective: Subclavian artery stenosis is generally subclinic in progress and known as subclavian steal syndrome. In our study, techniques which applied for surgical treatment of subclavian steal syndrome and their results were investigated. Material and Methods: We performed 22 surgical intervention to 21 patients who have subclavian artery stenosis in our clinic between January 2000 and December 2007. One of our case was bilateral subclavian artery stenosis diagnosed 36 years old woman; first of all we performed descendan aorta left subclavian artery bypass and 2 months later she underwent subclavia-subclavian bypass operation from left to right. 15 patients (71.4%) were male, 6 patients (28.6%) were female and mean age was 48 ± 13.9 (30 - 75). 18 patients had subclavian steal syndrome and 3 patients had coronary subclavian steal syndrome. The most common symptoms observed among patients were syncope, vertigo and claudicatio intermittance in upper extremity. All cases were received surgical treatment. The surgical procedure was subclavian – subclavian bypass in 9 patients, carotid–subclavian bypass in 6 patients, aorto–axillary bypass in 2 patient, subclavian–carotid end to side anostomosis in 2 patients, subclavian– brachial bypass in one patient and descendent aort–left subclavian bypass in 2 patient. Results: No perioperative and postoperative mortality was observed. Early postoperative complications were observed in 5 patients. Acute greft thrombosis developed in two of these patients and they underwent greft trombectomy and re–anostomosis. Other complications were bleeding and hematom in one patient, contra-lateral pulse loss in one patient and transient hemiparesis in one patient. No other complications were observed in long term follow up. Conclusion: Surgical treatment is performed in subclavian steal syndrome cases who are not suitable for percutaneous transluminal angioplasty. Succesful reconstriction can be performed with appropriate strategy developed according to the localisation of stenosis on subclavian artery, age of patient, additional lesion, accompanying disease and combined surgical approach.