Critical evaluation of axilloaxillary artery bypass for surgical management of symptomatic subclavian and innominate artery occlusive disease

The use of axilloaxillary artery bypass grafting as a successful approach for patients with symptomatic atherosclerosis of the brachiocephalic arteries has been described but remains limited as a result of concern over its subcutaneous, trans-sternal position and long-term patency. The aim of this study was to help define the indications, complications and patency of axilloaxillary artery bypass grafting for the treatment of subclavian and innominate artery occlusive disease. A retrospective review was performed of ten patients who underwent this operation over a 15-year period at the authors' institution and of 253 cases reported in the literature. The most common complication was transient brachial plexopathy, occurring in 3.5% of patients, and graft infection or skin erosion was noted in 1.6%. Incidence of perioperative myocardial infarction, stroke and death was <2%, in contrast to other approaches which may involve thoracotomy, sternotomy, or carotid dissection and clamping. Recent series, including the authors', report a long-term primary patency rate (> 5 years) of around 90%. Because of its ease of performance, low morbidity and mortality, and excellent long-term patency, the authors propose that the axilloaxillary artery bypass is the procedure of choice in appropriately selected patients with symptomatic occlusive disease of the innominate and subclavian arteries.