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Background and Aims: The authors examine the treatment of steno-occlusive diseases of the subclavian artery using transluminal percutaneous angioplasty in order to evaluate the correct indications and analyse the results., Methods: The classic method was used according to Gruentzig's technique, following the surgical isolation of the brachial artery. All 15 patients (11 males, 4 females, mean age 64 years old) were suffering from stenosis of the subclavian ischemia during physical exercise (13), resting (2) or vertebrobasilar insufficiency. Diagnostic evaluation took the form of bilateral sphynghomanometric measurement, echo-Doppler of the cervico-brachial vessels when resting and during exercise, as well as selective arteriography in 13 cases. Intra- and postoperative arteriographic control was always performed and the method was declared successful if residual stenosis was less than 30% with a delta AP between the two lower limbs of less than 10 mmHg. Mean follow-up was 12 months., Results: The immediate results included the onset of complications linked to hematoma of the arm and two small dissections of the subclavian artery which were treated conservatively. Residual stenosis, albeit not hemodynamically significant, appeared in 26.7% of patients (4 cases). One case of total occlusion without clinical symptoms and two non-hemodynamically significant re-stenoses were observed in the long term., Conclusions: The authors discuss the indications and results of this method and compare them with the data reported in the literature.

Background: Thrombosis is the most frequent late complication of surgical procedures in the aortofemoral area. In the presence of aortobifemoral bypass, graft limb occlusion generally occurs within the first two years. Various techniques have been proposed to revascularize the ischemic limb. Personal experience in the treatment of occlusions of aorto-femoral bypasses branch by femoro-femoral bypasses is reported and the immediate and long-term results are analyzed., Methods: The study was retrospective and the medium follow-up was 51 months (1-14 years). The patients were all operated from 1976 to 1995 in the Division of Vascular Surgery of the University of Bari. The group consisted of 40 patients affected by unilateral occlusion that occurred after aorto-femoral bypass. The femoro-femoral bypass was performed using non-ringed 6 or 8 mm Dacron prostheses; the proximal anastomosis was made a few cm above the femoral anastomosis of the permeable branch of the existing aorto-bifemoral bypass and the distal anastomosis on the cross-leg profunda femoris. Postoperative follow-up consisted of clinical examination, continuous wave Doppler examination or US-color-Doppler scan in order to assess the permeability of the graft., Results: The immediate results showed 2 and long-term results 9 occlusions of the bypass. No perioperative mortality was observed., Conclusions: In conclusion the authors consider the use of femoro-femoral bypass indicated in a high number of patients affected by unilateral occlusion of the aorto-bifemoral bypass.