Features of surgical treatment of patients with subclavian steal syndrome

Authors

  • I. I. Kopolovets Clinic of Vascular Surgery, East Slovak Institute of Cardiovascular Diseases, Pavol Jozef Šafárik University, Košice, Slovak Republic Uzhhorod National University http://orcid.org/0000-0002-2721-6114
  • M. Frankovichova Clinic of Vascular Surgery, East Slovak Institute of Cardiovascular Diseases, Pavol Jozef Šafárik University, Košice, Slovak Republic
  • P. Berek Clinic of Vascular Surgery, East Slovak Institute of Cardiovascular Diseases, Pavol Jozef Šafárik University, Košice, Slovak Republic
  • M. Kubikova Clinic of Vascular Surgery, East Slovak Institute of Cardiovascular Diseases, Pavol Jozef Šafárik University, Košice, Slovak Republic
  • P. O. Boldizhar Uzhhorod National University
  • V. V. Rusyn Uzhhorod National University

DOI:

https://doi.org/10.11603/2414-4533.2017.2.7707

Keywords:

carotid artery stenosis, subclavian steal syndrome, chronic cerebral ischemia, atherosclerosis.

Abstract

The aim of the work: to systematize the indications as well as to develop an algorithm for selection of patients with subclavian steal syndrome for surgical treatment.

Materials and Methods. The results of surgical treatment of 19 patients with subclavian steal syndrome were analyzed. All the patients were operated on when the possibilities of endovascular revascularization were exhausted. An arterial reconstruction was performed under general anaesthesia; transcranial oximetry was used to provide intraoperative neuromonitoring. Subclavian-carotid transposi­tion (9 patients, 47.4 %) was chosen as the preferred method of arterial reconstruction. In addition to transposition, carotid-subclavian bypass (5 patients, 26.3 %), carotid-carotid bypass (4 patients, 21.1 %) and prosthetic repair of the brachiocephalic trunk (1 patient, 5.3 %) were applied.

Results and Discussion. Patients with upper limb ischemia, stage I (36.8 %) and stage II (31.6 %) prevailed in the study group. Among patients with upper limb ischemia, stage I, there were 4 (21.1 %) persons selected for stent-graft implantation with the coverage of the ostium of the left common carotid artery. Upper limb ischemia, stage IV was observed in 2 (10.5%) patients. In the early postoperative period after carotid-carotid bypass, 1 (5.3%) patient developed ischemic stroke. 1 (5.3%) patient died after carotid-carotid bypass and stent-graft implantation. Tactics of treating patients with subclavian steal syndrome depends on the type of subclavian steal syndrome, the permeability state of the homo- and contralateral vessels responsible for the blood supply to the brain as well as the type of cere­brovascular disease.

Author Biography

I. I. Kopolovets, Clinic of Vascular Surgery, East Slovak Institute of Cardiovascular Diseases, Pavol Jozef Šafárik University, Košice, Slovak Republic Uzhhorod National University

Науково-дослідна частина, старший науковий співробітник

References

Синдром обкрадання при патології судин дуги аорти / В.І. Русин, В.В. Корсак, Є.С. Буцко[ та.ін.] — Ужгород: Карпати, 2011. — 208 с.

Хирургическое лечение пациентов с синдромом подключично-позвоночного обкрадывания / В.Б. Стародубцев, А.А. Карпенко, С.А. Альсов [ и др.] // Патология кровообращения и кардиохирургия. — 2009. — №1. — С. 61–64.

Никульников И.П. Тактика хирургического лечения множественных атеросклеротических поражений ветвей дуги аорты / И.П. Никульников, А.В. Ратушнюк, П.А. Зайченко [и др.] // Ангиология и сосудистая хирургия. М. — 2005. — № 2. — С. 221 – 222.

Можливості ендоваскулярного лікування атеросклеротичного ураження екстракраніальних артерій у гострий період ішемічного інсульту / В.І. Русин, В.В. Корсак, Є.С. Буцко, А.Г. Голяка // Науковий вісник Ужгородського університету серія медицина. — 2014. — Випуск 1(49). — С. 144 — 149.

Прогрессирующий церебральный атеросклероз: клинические, биохимические и морфологические аспекты / М.М. Танашян, О.В. Лагода Т.С. Гулевская [и др.] // Анналы клинической и экспериментальной неврологи. — 2013. — №4. — С. 4 — 9.

Sihotský V. Metodou prvej voľby pri stenóze karotid je CEA / V. Sihotský // Cesk Slov Neurol. — 2016. — 79:112(4). — P. 397–399.

Родин Ю.В. Оперативное лечение больных с патологией брахиоцефальных артерий с верхвысокого неврологического риска / Ю.В. Родин, В.А. Симонян, Д.Ш. Дюба // Хірургія України. — 2008. — Т.2, № 4 (додаток). — С. 253 – 255.

Kurisu K. Carotid artery stenting in a patient with right-sided aortic arch with an aberrant left subclavian artery / K. Kurisu // Acta Neurochir (Wien). — 2011. — 153. — P. 2169 –2173.

Morasch M. D. Technique for subclavian to carotid transposition, tips, and tricks / M.D. Morasch // J vasc. Surg. — 2009. — V.49/1. — P. 251 – 254.

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Published

2017-07-14

How to Cite

Kopolovets, I. I., Frankovichova, M., Berek, P., Kubikova, M., Boldizhar, P. O., & Rusyn, V. V. (2017). Features of surgical treatment of patients with subclavian steal syndrome. Hospital Surgery. Journal Named by L.Ya. Kovalchuk, (2), 55–60. https://doi.org/10.11603/2414-4533.2017.2.7707

Issue

No. 2 (2017)

Section

EXPERIENCE OF WORK

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