Surgical management of atheroma of the aortic dome and origin of supra‐aortic trunks

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Abstract
During a 14‐year period, 607 obstructive lesions of supraaortic vessels originating from the aortic arch in 506 patients were submitted to arterial reconstruction. Among these, 28 patients presented multiple proximal aortic arch lesions associated with extensive aortic involvement—an “aortic dome syndrome.” Transsternal revascularization procedures were performed in 28 patients, including 7 in whom endarterectomy of the aortic dome was done under hypothermic circulatory arrest. In addition, in 11 patients, multiple bypass grafts were constructed from the ascending aorta, and in 10 other patients, sequential great vessel endarterectomies were performed, with transposition of the left common carotid artery in 5 patients. Twenty‐four of the 27 survivors are asymptomatic at an average of 6.9 years postoperatively. Progressive atherosclerosis in distal lesions has been observed in 2 patients, and late mortality has occurred in 5 others. Long‐term arterial patency has been demonstrated for follow‐up periods of from 1 to 14 years.