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Atherosclerotic Disease of the proximal brachiocephalic circulation may produce disabling symptoms referable to cerebral or upper extremity hypoperfusion and embolization.Bypass of occlusive lesions can provide durable relief of symptoms with minimal complications.The ideal conduit for carotid-to-subclavian and subclavian-to-carotid bypass remains controversial,and it is not clear whether the outflow vessel influences patency and survival.The outflow vessel does not affect long-term patency in carotid and subclavian bypass procedures;however,patients with common carotid disease demonstrate significantly poorer long-term survival. Transposition results in superior long-term patency,with a trend toward lower results for synthetic grafts and relatively poor results for autogenous vein grafts. |
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