35694 Transposition and/or reimplantation; subclavian to carotid artery

Name of the Procedure:

Transposition and/or Reimplantation; Subclavian to Carotid Artery
Common name(s): Subclavian Carotid Transposition, Subclavian Carotid Reimplantation

Summary

This surgical procedure involves rerouting the subclavian artery to the carotid artery to restore proper blood flow. It is usually performed to treat blockages or injuries in the subclavian artery that affect blood flow to the arm or brain.

Purpose

Medical Condition:

• Blockages or stenosis in the subclavian artery.
• Trauma or injury affecting the subclavian artery. ##### Goals:
• Restore adequate blood flow from the heart to the arms and brain.
• Prevent symptoms such as arm weakness, pain, or dizziness.

Indications

Symptoms/Conditions:

• Severe atherosclerosis causing subclavian stenosis or occlusion.
• Subclavian steal syndrome, where blood flow is reversed away from the brain.
• Ischemic symptoms in the arms or brain due to compromised blood flow. ##### Patient Criteria:
• Diagnosed with significant subclavian artery disease or injury.
• Symptoms not manageable by medication alone.

Preparation

Pre-procedure Instructions:

• Fasting typically required 6-8 hours before the procedure.
• Medication adjustments (e.g., blood thinners). ##### Diagnostic Tests:
• CT or MR angiography to visualize the arteries.
• Blood work to check overall health status.

Procedure Description

• Step 1: Administer general anesthesia.
• Step 2: Make an incision near the neck to expose the subclavian and carotid arteries.
• Step 3: Disconnect the subclavian artery from its original position.
• Step 4: Reconnect the subclavian artery to the carotid artery.
• Step 5: Carefully stitch the arteries to ensure no leaks. ##### Tools/Equipment:
• Surgical clamps.
• Sutures.
• Vascular grafts (if necessary).
• Angiography equipment to monitor blood flow during the procedure. ##### Anesthesia:
• General anesthesia to ensure the patient is fully unconscious and pain-free.

Duration

Typically, the procedure takes about 2-4 hours.

Setting

Performed in a hospital operating room.

Personnel

• Vascular surgeon.
• Surgical assistants.
• Anesthesiologist.
• Operating room nurses.

Risks and Complications

Common Risks:

• Infection at the incision site.
• Bleeding or hematoma formation. ##### Rare Risks:
• Blood clots.
• Stroke.
• Nerve damage. ##### Management of Complications:
• Close monitoring and prompt intervention if complications arise.

Benefits

• Restored blood flow to the arms and brain.
• Relief from symptoms like arm pain, weakness, and dizziness.
• Reduced risk of stroke related to subclavian artery disease. ##### Realization of Benefits:
• Improved symptoms typically noticed within a few days to weeks.

Recovery

Post-Procedure Care:

• Hospital stay for 1-3 days for monitoring.
• Pain management with prescribed medications.
• Instructions on wound care. ##### Recovery Time:
• Full recovery usually takes 4-6 weeks.
• Follow-up appointments to assess healing and blood flow.

Alternatives

Other Treatment Options:

• Angioplasty or stenting of the subclavian artery.
• Conservative management with medications. ##### Pros and Cons:
• Angioplasty/Stenting: Less invasive but may not be suitable for all blockages.
• Conservative Management: Non-invasive but may not adequately relieve symptoms or risks.

Patient Experience

During Procedure:

• Fully sedated under general anesthesia. ##### After Procedure:
• May experience pain or discomfort around the incision site.
• Pain management through prescribed medications.
• Gradual return to normal activities as healing progresses.