Ask Dr. Z

Please help with the following case: "Patient had right subclavian artery occlusion. Upon incision and exposure of the distal common carotid artery, it was found to be amenable for use as an inflow vessel for a bypass. Then the axillary artery was exposed and good for use as target vessel. A tunnel was created between the common carotid and infraclavicular incision to allow for passage of the bypass graft. A plane was created underneath the clavicle connecting the two incisions, and an 8 mm ring PTFE graft was selected for the conduit. The conduit was passed through the tunnel, and the PTFE graft was passed through the tunnel. Arteriotomy was created over the common carotid artery and anastomosis created in an end-to-side fashion. Flow was restored through the graft to the right carotid artery. Arteriotomy was then created over the axillary artery. The vascular graft was then cut for a wide spatulated anastomosis. The anastomosis was then created in an end-to-side fashion between the graft and the axillary artery. A strong brachial artery was noted upon completion of the bypass."