Exposure of the brachiocephalic vessels

Although the possible combinations of reconstructive procedures used for brachiocephalic arterial lesions are innumerable, all can be performed using four or five basic incisions, singly or in combination, separately or joined by extension. For a number of reasons, not the least of which is that endarterectomy requires more favorable, discrete lesions, bypasses are much more commonly performed than endarterectomy. Direct reconstructions using bypass grafts emanating from the aorta obtain superb patencies but, in the older arteriosclerotic patient with multiple risk factors, cervical bypasses hold the advantage of lower morbidity and mortality. The more common of the cervical or extra-anatomic reconstructions such as carotidsubclavian bypass or transposition themselves have excellent patency.