Considerations in extrathoracic reconstruction for disease of the branches of the aortic arch

The effectiveness and decreased morbidity and mortality of extrathoracic reconstruction for disease of branches of the aortic arch has been reported by several workers; however, there has been relatively little discussion in the literature in regard to designing the operation to correct the pathophysiologic process of the disease (embolism versus flow reduction). The technique of reconstruction should be selected with regard to a patient's symptoms and arteriographic findings, with embolic phenomena more likely in patients with cerebral hemispheric symptoms and arteriographic stenosis rather than total occlusion. Simple bypass for suspected proximal embolic disease is inadequate.