Carotid to subclavian bypass, rare but rewarding surgery: A case report

Abstract

Different treatment options are available for subclavian stenosis (SS). Carotid to subclavian bypass surgery (CSBS) is an increasingly used effective treatment strategy when stenting is impossible. However, in Nepal, little is known about SS and its management. A 58-year-old man with a history of aortic valve replacement surgery complained of progressive left arm weakness for the past 6 months associated with pain on exertion and blood pressure discrepancies in both arms. A computed tomographic scan confirmed near-complete subclavian artery stenosis and a Doppler ultrasound showed decreased blood flow and systolic velocity. CSBS was selected as stenting was not feasible. Post-CSBS, all hemodynamic parameters returned to normal, lasting even after 2 years. CSBS appears to be a viable, safe, and promising treatment for symptomatic SS. However, additional studies need to be conducted to analyze the benefits of CSBS relative to other interventions.

Keywords

Carotid arteries / Subclavian artery / Subclavian steal syndrome / Vascular surgical procedures

References

[1] Shadman R, CriquiMH, Bundens WP, et al. Subclavian artery steno-sis: prevalence, risk factors, and association with cardiovascular diseases. J Am Coll Cardiol. 2004; 44(3): 618-23. PMid:15358030. https://doi.org/10.1016/j.jacc.2004.04.044

[2] Nishikii H, KuritaN, Kusakabe M, et al. [Successful management of primary immune thrombocytopenia with romiplostim during open heart surgery in a hemodialysis patient]. Rinsho Ketsueki. 2019; 60(1): 28-32.

[3] AbuRahma AF, Robinson PA, Jennings TG. Carotid-subclavian by- pass grafting with polytetrafluoroethylene grafts for symptomatic subclavian artery stenosis or occlusion: a 20-year experience. J Vasc Surg. 2000; 32(3): 411-8; discussion 418-419. PMid:10957647. https://doi.org/10.1067/mva.2000.108644

[4] Salman R, Hornsby J, Wright LJ, et al. Treatment of subclavian artery stenosis: A case series. Int J Surg Case Rep. 2015; 19: 69-74. PMid:26722712. https://doi.org/10.1016/j.ijscr.2015.12.011

[5] Diethrich EB, Garrett HE, Ameriso J, et al. Occlusive disease of the common carotid and subclavian arteries treated by carotid-subclavian bypass. Analysis of 125 cases. Am J Surg. 1967; 114(5): 800-8. PMid:5603339. https://doi.org/10.1016/0002-9610(67)90151-1

[6] Vitti MJ, Thompson BW, Read RC, et al. Carotid-subclavian bypass: a twenty-two-year experience. J Vasc Surg. 1994; 20(3): 411-7; discussion 417-418. PMid:8084034. https://doi.org/10.1016/0741-5214(94)90140-6

[7] AbuRahma AF, Bates MC, Stone PA, et al. Angioplasty and stenting versus carotid-subclavian bypass for the treatment of isolated subclavian artery disease. J Endovasc Ther Off J Int Soc Endovasc Spec. 2007; 14(5): 698-704. PMid:17924737. https://doi.org/10.1177/152660280701400515

[8] Basukala S, Pathak BD, Rijal S, et al. Subclavian steal syndrome secondary to atherosclerosis: A case report and review of literature. Clin Case Rep. 2022; 10(4): e05740. https://doi.org/10.1002/ccr3.5740

[9] Schillinger M, Haumer M, Schillinger S, et al. Risk stratification for subclavian artery angioplasty: is there an increased rate of restenosis after stent implantation? J Endovasc Ther Off J Int Soc Endovasc Spec. 2001; 8(6): 550-7. PMid:11797967. https://doi.org/10.1177/152660280100800603

[10] van der Vliet JA, Palamba HW, Scharn DM, et al. Arterial reconstruc- tion for subclavian obstructive disease: a comparison of extrathoracic procedures. Eur J Vasc Endovasc Surg Off J Eur Soc Vasc Surg. 1995; 9(4): 454-8. PMid:7633992. https://doi.org/10.1016/S1078-5884(05)80015-2

[11] Song P, Rudan D, Zhu Y, et al. Global, regional, and national prevalence and risk factors for peripheral artery disease in 2015: an updated systematic review and analysis. Lancet Glob Health. 2019; 7: e1020-e1030. PMid:31303293. https://doi.org/10.1016/S2214-109X(19)30255-4

[12] Van Dyck M, Glineur D, de Kerchove L, et al. Complications after aortic valve repair and valve-sparing procedures. Ann Cardiothorac Surg. 2013; 2(1): 130-9.