Brachiocephalic Arterial Reconstruction

Publisher Website
Google Scholar
Abstract
From 1965 through 1980, 51 men and 49 women (mean age 55 yr) underwent transthoracic or extrathoracic revascularization of the innominate, common carotid, subclavian or vertebral arteries. Preoperative symptoms were limited to the vertebrobasilar syndrome in 29 patients, to hemispheric neurologic or monocular visual events in 19 and upper extremity ischemia in 13. Multiple symptoms were present in 27 other patients, and 12 patients were asymptomatic before operation. Median sternotomy was performed for correction of innominate, common carotid or subclavian lesions in 34 patients, including 6 simultaneous brachicephalic and cardiac procedures, with 5 operative deaths (14.7%). Extrathoracic reconstruction, such as carotosubclavian and axilloaxillary bypass or vertebral endarterectomy and reimplantation, was employed in 66 patients, with 2 operative strokes but no mortality (P < 0.01). Late results were obtained from 2 to 189 mo. after operation (mean 52 mo.). Considering their original symptoms, 82 patients were classified as asymptomatic or improved, 9 as unchanged and 9 others, including those who had operative complications, as worse. Twelve patients eventually sustained either transient cerebral ischemia (6) or strokes (6), most of which were unrelated to 8 documented late operative failures. In addition to 20 patients who required combined brachiocephalic and carotid bifurcation reconstruction, 27 additional carotid endarterectomies have at some time been necessary for patients have died during the follow-up interval, including 8 with myocardial infarctions, but only 1 with a fatal stroke.