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Brachiocephalic arterial reconstruction.

D P Vogt, N R Hertzer, P J O'Hara

    Annals of Surgery
    |November 1, 1982
    PubMed
    Summary
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    Revascularization surgery for brachiocephalic and vertebral arteries improved outcomes for most patients. Extrathoracic procedures showed significantly lower mortality and stroke rates compared to transthoracic approaches.

    Area of Science:

    • Vascular Surgery
    • Cerebrovascular Disease Management
    • Arterial Reconstructive Procedures

    Background:

    • Atherosclerotic disease affecting the brachiocephalic and vertebral arteries can lead to significant cerebrovascular and upper extremity ischemic events.
    • Surgical revascularization aims to restore blood flow and alleviate symptoms associated with these conditions.

    Purpose of the Study:

    • To evaluate the long-term outcomes of transthoracic and extrathoracic revascularization procedures for innominate, carotid, subclavian, and vertebral arteries.
    • To compare the safety and efficacy of different surgical approaches in managing extensive cerebrovascular disease.

    Main Methods:

    • A retrospective review of 51 men and 49 women (mean age 55) who underwent revascularization between 1965 and 1980.
    • Procedures included transthoracic (median sternotomy) and extrathoracic (bypass, endarterectomy) reconstructions.

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  • Patient symptoms, operative details, complications, and long-term follow-up (mean 52 months) were analyzed.

    • Main Results:

    • Extrathoracic reconstruction in 66 patients resulted in no operative mortality and only two strokes (p < .01), significantly better than transthoracic procedures in 34 patients (14.7% operative mortality).
    • Overall, 82 patients were asymptomatic or improved post-operatively; nine were unchanged, and nine were worse.
    • Late complications included transient cerebral ischemia or strokes in 12 patients, often unrelated to operative failures. Myocardial infarctions were the leading cause of late death.

    Conclusions:

    • Extrathoracic revascularization offers a safer and more effective alternative to transthoracic approaches for brachiocephalic and vertebral artery disease.
    • Surgical intervention can significantly improve outcomes for patients with extensive cerebrovascular disease, despite potential late complications.