Reconstruction of supraaortic branches

Abstract

The authors present surgical techniques and distant results of the operative treatment in patients with occlusive lesions of the supraaortic branches. The study included 29 men (55.8%) and 23 women (44.2%), with the average age of 54 years. The majority of patients--44 (84.6%) had symptoms and signs of the upper extremities ischemia while 25 (48.1%) had symptoms and signs of cerebral ischemia (the posterior circulation mainly). Among seven patients with isolated cerebral ischemia of the anterior circulation, four of them developed transient ischemic attack (TIA) and three had cerebrovascular insult (CVI). All patients were examined ultrasonographically and angiographically. Operative treatment was performed under general anesthesia. In eight cases the anatomic, and in 44 extraanatomic procedure was applied. Following reconstructive procedures were used: endarterectomy and patch of the brachiocephalic trunk--2, bypass from ascending aorta--7, carotid to subclavian bypass--31, subclavian to carotid bypass--7, subclavian artery transposition--3, axillo-axillary bypass--2. During the follow-up period (10-228 months), eight out of 52 patients exhibited the occlusion of the graft. Six occlusions developed after carotid-subclavian bypass: in two patients reconstructions were performed using Dacron grafts, in three using PTFE grafts and in one patient using autologous vein graft. Two occlusions developed after subclavio-carotid bypass. In both cases the vein graft was used: one was coming from the ipsilateral and the other one from the contralateral subclavian artery. The mean period from the operation to the occlusion of the graft (the mean lasting of the primary flow) was 14.72 years (SE = 1.41; 95% CI = 11.96-17.48). There was no statistically significant difference in primary patency and survival without symptoms between patients treated with the anatomic and those treated with the extraanatomic approach. Practically, this means that both approaches were equally good, so that the decision about the approach should be made individually, according to the loading factors of each patient. In the case of the carotid-subclavian bypass, according to our results, we recomend the use of the PTFE graft.