Brachiocephalic arterial reconstruction

From 1965 through 1980, 51 men and 49 women (mean age: 55 years) underwent transthoracic or extrathoracic revascularization of the innominate, common carotid, subclavian, or vertebral arteries. Preoperative symptoms were limited to the vertebrobasilar syndrome in 29 patients, to hemispheric neurologic or monocular visual events in 19, and to upper extremity ischemia in 13. Multiple symptoms were present in 27 other patients, and 12 patients were asymptomatic before operation. Median sternotomy was performed for correction of innominate, common carotid, or subclavian lesions in 34 patients, including six simultaneous brachiocephalic and cardiac procedures, with five operative deaths (14.7%). Extrathoracic reconstruction, such as carotosubclavian and axilloaxillary bypass or vertebral endarterectomy and reimplantation, was employed in 66 patients, with two operative strokes but no mortality (p less than .01). Late results were obtained from two to 189 months after operation (mean: 52 months). Considering their original symptoms, 82 patients have been classified as asymptomatic or improved, nine as unchanged, and nine others, including those who had operative complications, as worse. Twelve patients have eventually sustained either transient cerebral ischemia (six) or strokes (six), most of which were unrelated to eight documented late operative failures. In addition to 20 patients who required combined brachiocephalic and carotid bifurcation reconstruction, 27 additional carotid endarterectomies have at some time been necessary for patients having extensive cerebrovascular disease. Twenty patients have died during the follow-up interval, including eight with myocardial infarctions, but only one with a fatal stroke.