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Peripheral Arterial Disease (PAD) (Expert Forum)
Subclavian Artery Blocked
Answered by
Lee Kirksey, MD - Peripheral Arterial Disease, PAD, Cardiovascular Disease, stroke, treatment, angioplasty, spider veins, laser ablation, wound treatment, surgery, leg pain, Prevention, Varicose veins
Penn Presbyterian Medical Center of the Univ. of Pennsylvania Healthcare Clinical Assistant Professor at The University of Pennsylvania School of Medicine
Philadelphia - PA
Questions in the Peripheral Arterial Disease forum are answered by Dr. Lee Kirksey, associate professor at The University of Pennsylvania School of Medicine. Topics covered include abdominal aortic aneurysm, amputation, arteriovenous fistula, atherectomy, carotid artery surgery, cholesterol, claudication, deep vein thrombosis (DVT), endovascular aortic stent graft (EVAR), stent placement, stroke prevention, varicose veins, and venous insufficiency.
Subclavian Artery Blocked
by SHYPENNY, May 10, 2008 04:21PM
Could you tell me about what choices are out there for a by-pass (Subclavian Artery) using man-made material or possible pig artery? How long will they last? Why would a doctor want to use part of me when I have already had 4 left/1 right common iliac stent placement and Rt. Carotid Endarterectomy with patch? The block is in a very usual place and too blocked for a stent.
Doctor's Answer
by Lee Kirksey, MD, May 10, 2008 07:27PM
, May 10, 2008 07:27PM
To: ShyPenny
Hello
Im not sure in your last sentence if you meant usual. I suspect that you mean unusual. The most common location of a subclavian artery blockage is at the beginning of the blood vessel as it branches from the aorta. Many of these blockages may be treated by a minimally invasive approach with a puncture from the elbow region of the arm or the femoral artery in the groin. It would be difficulty for me to determine feasibility without seeing your arteriogram diagnostic test. In most cases when I treat this type of blockage, I always attempt to treat it in a minimally invasive fashion prior to proceeding to a bypass.
When a bypas is necessary depending upon the location of the blockage, different operations may be possible. In a minority of cases, we are able to swing the unblocked portion of the subclavian artery over to the carotid vessel. Most of the time however, we use a prosthetic (plastic, dacron) tube to reroute the blood from the carotid over to the subclavian.
Anytime we use plastic, the risk of infection is slightly higher.
Recently, alternative bypass conduits like bovine (cow) arteries are available and would be another alternative although I personally have no experience with bovine artery for this purpose.
The durability of all substances in this type of bypass are very good because of the high rate of blood flow. That means over 80% stay open for at least 5 years.
Im not sure what the relevance of your common iliac stents are to this problem. I dont think that should affect the choice of bypass conduit.
Before proceeding with open bypass, I would get a thorough explanation and consider second opinion to see if minimally invasive treatment if possible. good luck
Im not sure in your last sentence if you meant usual. I suspect that you mean unusual. The most common location of a subclavian artery blockage is at the beginning of the blood vessel as it branches from the aorta. Many of these blockages may be treated by a minimally invasive approach with a puncture from the elbow region of the arm or the femoral artery in the groin. It would be difficulty for me to determine feasibility without seeing your arteriogram diagnostic test. In most cases when I treat this type of blockage, I always attempt to treat it in a minimally invasive fashion prior to proceeding to a bypass.
When a bypas is necessary depending upon the location of the blockage, different operations may be possible. In a minority of cases, we are able to swing the unblocked portion of the subclavian artery over to the carotid vessel. Most of the time however, we use a prosthetic (plastic, dacron) tube to reroute the blood from the carotid over to the subclavian.
Anytime we use plastic, the risk of infection is slightly higher.
Recently, alternative bypass conduits like bovine (cow) arteries are available and would be another alternative although I personally have no experience with bovine artery for this purpose.
The durability of all substances in this type of bypass are very good because of the high rate of blood flow. That means over 80% stay open for at least 5 years.
Im not sure what the relevance of your common iliac stents are to this problem. I dont think that should affect the choice of bypass conduit.
Before proceeding with open bypass, I would get a thorough explanation and consider second opinion to see if minimally invasive treatment if possible. good luck
The type of blood vessel that is blocked is an artery, the subclavian artery. the type of blood vessel that you have stents in is an artery. An artery takes blood Away from your heart to your body's organs. The vessel that we use for a bypass is a Vein. When we use a vein, it is usually the greater saphenous vein which is a superficial vein that your body does not miss. Unfortunately the greater saphenous vein is usually only use for bypasses of the arteries of the leg or heart because it is similar in size to those structures. It is too small to use for your aorta, iliac arteries , carotid or subclavian vessels. for those vessels we commonly use prosthetic which is very durable. For a carotid endarterectomy, prosthetic is used 95% of the time. The durability is very good for prosthetic under these circumstances
Thank you for that information, puts my mind at ease. Now that I have my legs back, I don't want them touched. But now I have another question. What would be the problems if they opened the right subclavian artery up like they did with the carotid artery? Seems to me it would last longer than 5 yrs which is what I'm looking at with a bypass. It's just too bad its so blocked that I could not have a stent which is what they tryed to perform.
Thank you again.
-Kathleen