Aortobrachiocephalic reconstruction
W E Evans1, T E Williams, J P Hayes
1Department of Surgery, Ohio State University College of Medicine, Columbus.
Insights
Direct revascularization of the arch branches, including the carotid artery and innominate arteries, offers a safe and effective treatment for aortobrachiocephalic disease. This surgical approach provides significant symptom relief with low morbidity and mortality rates.
Area of Science:
- Vascular Surgery
- Cardiovascular Surgery
- Thoracic Surgery
Background:
- Aortobrachiocephalic disease affects major arteries branching from the aortic arch.
- Previous interventions like stroke treatment or carotid endarterectomy may complicate surgical management.
- Direct revascularization aims to restore blood flow to these critical cerebral and upper extremity arteries.
Purpose of the Study:
- To evaluate the safety and efficacy of direct revascularization for aortobrachiocephalic reconstruction.
- To assess outcomes in terms of morbidity, mortality, and symptom relief.
Main Methods:
- Retrospective analysis of 26 patients undergoing aortobrachiocephalic reconstruction.
- Ascending aorta as the proximal anastomotic site for bypass grafting.
- Reconstructions involved carotid artery, innominate arteries, or both, with varying numbers of distal anastomoses.
Main Results:
- Low postoperative mortality (7%) and high symptom relief rate (96%) in survivors.
- Minimal morbidity associated with the procedure.
- Successful revascularization of arch branches, addressing complex arterial disease.
Conclusions:
- Direct revascularization of the aortic arch branches is a viable surgical option.
- The procedure demonstrates acceptable safety profiles and durable symptom resolution.
- This technique offers a durable solution for patients with complex aortobrachiocephalic disease.
Abstract:
Aortobrachiocephalic reconstruction was studied in 26 patients. Nine had suffered a previous stroke, and seven had residual deficity. A previous carotid endarterectomy or carotid-to-subclavian bypass had been performed in eight patients. The ascending aorta was the proximal anastomotic site in all cases. Bypass grafting to a single distal site was performed in 11 patients (42 percent), to 2 distal sites in 14 patients (54 percent) and to 3 distal sites in 1 patient (4 percent). The carotid artery, innominate arteries, or both were involved in all reconstructions. Concomitant carotid or subclavian endarterectomy was performed in 14 patients, 1 of whom also had a coronary bypass at the same time. Two patients (7 percent) died in the postoperative period. Twenty-three of 24 survivors (96 percent) had relief of symptoms after operation. Only one patient had worsening of symptoms postoperatively, which was secondary to intracerebral hemorrhage. Results of this study indicate that direct revascularization of the arch branches can be carried out with minimal morbidity and mortality. Relief of presenting symptoms is to be expected, and long-term results suggest that the operation is durable.
