Retrograde conduit-assisted hybrid repair for tandem common carotid and subclavian lesions

Abstract

Background

Tandem occlusive disease involving both the common carotid artery (CCA) and subclavian artery (SCA) presents a unique technical challenge. Open bypass procedures remain durable but carry significant morbidity, particularly in patients with prior sternotomy or hostile arch anatomy. We describe a novel hybrid technique that combines retrograde stenting via a prosthetic conduit anastomosed between the CCA and SCA, allowing single-incision revascularization while avoiding the aortic arch.

Methods

Patients who underwent retrograde conduit-assisted hybrid repair between January 2019 and December 2024 were retrospectively identified. Data collected included demographics, comorbidities, intraoperative details, and postoperative outcomes. Patency was confirmed by duplex ultrasound at follow-up.

Results

Six patients (mean age 71 years, 4 female) underwent this hybrid procedure for combined CCA and SCA occlusive disease. Four had prior sternotomy or anticipated cardiac surgery precluding open arch exposure. All procedures were performed via a single supraclavicular incision using a Hemashield ® graft as a conduit for retrograde stenting, followed by anastomosis to the SCA. Technical success and 30-day graft patency were achieved in all patients, with no perioperative strokes or deaths. Complications included one pulmonary embolism and one chyle leak. Long-term patency was maintained over one year in all patients.

Conclusions

Retrograde conduit-assisted hybrid repair enables safe, durable revascularization of tandem carotid and subclavian lesions through a single incision. By avoiding sternotomy and arch manipulation, this approach offers a practical solution for patients with complex anatomy or prior thoracic surgery.