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Common brachiocephalic trunk: strategies for revascularization.
A Azakie1, D B McElhinney, L M Messina
1Division of Vascular Surgery, University of California, San Francisco 94143-0222, USA.
The Annals of Thoracic Surgery
|April 24, 1999
Summary
Revascularization effectively treats occlusive disease of the common brachiocephalic trunk, a variant affecting 10% of people. Surgical options like bypass grafts or endarterectomy offer durable symptom relief but carry risks of neurological complications.
Area of Science:
- Vascular Surgery
- Cerebrovascular Disease
- Aortic Arch Anatomy
Background:
- Common brachiocephalic trunk (CBT) is a normal aortic arch variant in ~10% of the population.
- CBT supplies major cerebral blood flow; stenosis/occlusion causes severe ischemia.
- Limited data exists on managing occlusive CBT disease.
Purpose of the Study:
- To review management options for occlusive disease of the common brachiocephalic trunk.
- To evaluate the efficacy and durability of revascularization procedures for CBT occlusive disease.
Main Methods:
- Retrospective review of 6 patients with symptomatic CBT occlusion or stenosis (1977-1997).
- Revascularization via ascending aorta to innominate/carotid bypass (n=5) or endarterectomy (n=1).
- Underlying causes included atherosclerosis (n=5) and Takayasu's arteritis (n=1).
Main Results:
- One perioperative death (myocardial infarction) and one stroke.
- One case of cerebral hyperperfusion syndrome resolved with medication.
- Long-term follow-up (1-20 years) showed no symptomatic recurrence in survivors.
Conclusions:
- Revascularization using bypass grafts or endarterectomy provides effective symptom relief for occlusive CBT disease.
- Neurologic complications, including one fatality, highlight the risks associated with CBT occlusive disease and its treatment.