Related Experiment Videos
Brachiocephalic arterial reconstruction
H Van Damme1, D Caudron, J O Defraigne
1Department of Thoracic and Cardiovascular Surgery, University Hospital Sart-Tilman, Liège.
Insights
Trans-sternal repair effectively treated brachiocephalic artery occlusive disease, relieving symptoms in all patients. Surgical reconstructions remained patent at follow-up, showing good long-term outcomes.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Brachiocephalic artery occlusive disease presents with diverse neurological and limb ischemia symptoms.
- Surgical intervention is crucial for managing severe stenosis or occlusion.
- Takayasu arteritis can affect the brachiocephalic artery, requiring specific treatment considerations.
Purpose of the Study:
- To evaluate the efficacy and safety of trans-sternal repair for brachiocephalic artery occlusive disease.
- To assess symptom relief and long-term patency of surgical reconstructions.
- To analyze patient demographics, clinical presentations, and associated vascular pathologies.
Main Methods:
- Retrospective analysis of 18 patients undergoing trans-sternal repair from 1980-1990.
- Surgical techniques included thromboendarterectomy with patch angioplasty and aorto-brachiocephalic bypass grafting.
- Postoperative assessment included symptom evaluation and duplex echo scan for patency confirmation.
Main Results:
- No operative mortality was observed.
- All 18 patients experienced symptom relief post-surgery.
- Duplex echo scan confirmed patency of all reconstructions at a mean follow-up of 46 months.
- Postoperative morbidity included pulmonary infection, transient neurologic deficit, and renal insufficiency.
Conclusions:
- Trans-sternal repair is a safe and effective treatment for brachiocephalic artery occlusive disease.
- The procedure provides durable symptom relief and maintains graft patency.
- Early surgical intervention is recommended for symptomatic patients with brachiocephalic artery stenosis or occlusion.
Abstract:
From 1980 to 1990, 18 patients underwent trans-sternal repair for occlusive disease of the brachiocephalic artery. The mean age was 57 years (43-72). Most of the patients were women (n = 10). All but two patients had one or more symptoms related to the stenosis of the brachiocephalic trunk: right-sided upper limb ischemia (n = 7), transient ischemic attacks (n = 8), vertebrobasilar insufficiency (n = 6), left sided minor stroke (n = 1). Only two patients were asymptomatic before operation. Angiography revealed a tight stenosis (n = 14) or an occlusion (n = 3); in one patient it concerned an ulcerated non-stenotic plaque of the brachiocephalic artery. Eleven patients had coexistent involvement of other supraaortic vessels. Angiographically, clinically and intraoperatively, there was evidence of Takayasu arteritis in three female patients. All patients had direct repair by trans-sternal approach. Six patients with short lesions had thromboendarterectomy with patch angioplasty of the innominate artery. In eleven cases, aorto-brachiocephalic bypass grafting was performed. In one patient, aortic calcification precluded proximal anastomosis, and a carotid-to-carotid bypass was done. In five patients, simultaneous revascularization of subclavian (n = 3), left common carotid (n = 2) or internal carotid artery (n = 2) completed the procedure. In one patient, concomitant coronary revascularization was done. There was no operative mortality. Postoperative morbidity was limited to pulmonary infection (n = 2), transient neurologic deficit (n = 1) and renal insufficiency (n = 1). All patients had relief of symptoms. Duplex echo scan confirmed patency of all reconstructions at a mean follow-up of 46 months.(ABSTRACT TRUNCATED AT 250 WORDS)