Optimally, coverage of the left subclavian artery orifice should be revascularized. The most widely used method of revascularization is the carotid-subclavian bypass. This is commonly performed by vascular surgeons, and is associated with morbidities related to phrenic nerve and thoracic duct injuries that are not uncommon. Carotid-axillary bypass is an alternative revascularization strategy that is equally effective, safer for the phrenic nerve and the thoracic duct, and has a technically familiar anatomy and exposure for cardiac surgeons.
In this video, the authors present their technique for carotid-axillary bypass. The method includes using a retroclavicular routed conduit followed by left subclavian embolization in the context of zone II TEVAR.
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2 Comments
Thank you
Would you consider constructing the axillary anastomosis first to avoid pulling on the ipsilateral common carotid?
Thank you for your comment. I think either works fine. There should not be tension or pulling on either arteries regardless of the sequence of anastomoses. Thank your again.