Peripheral Vascular Surgery Society

#1 CLINICAL EFFICACY OF BRACHIOCEPHALIC REVASCULARIZATION.

Jonathan-Hien Vu, MD, James E. Mazo, MD, John Blebea, MD, Karla Anderson, MD, and Robert G. Atnip, MD

Hershey Medical Center, Hershey, PA.

Purpose: Revascularization of atherosclerotic occlusive lesions of aortic arch vessels are infrequent and challenging vascular procedures. We reviewed our experience and report on the objective and symptomatic long-term results.

Patients: We retrospectively reviewed a consecutive series of 47 patients who underwent 50 brachiocephalic revascularizations from 1985 to 1998. The indications for surgery were upper extremity ischemic symptoms in 36% (17) patients, neurologic symptoms in 26% (12), combined extremity ischemia and neurologic symptoms in 32% (15), while the remaining three patients were asymptomatic. The locations of the stenotic lesions included the subclavian (n=38), common carotid (n=12), and innominate (n=8) arteries. Of these patients, 37 (79%) underwent an extrathoracic bypass (ETB) while 10 (21%) had an intrathoracic bypass (ITB). Postoperative patency was confirmed by duplex scanning.

Results: There was one perioperative death. Major morbidities included: two strokes (4%), two TIA's (4%), and six nerve injuries (13%). With the exception of one stroke and one perioperative death in the ITB group (2/10; 20%), all the remaining complications (16/37; 43%) were in the ETB patients. The primary bypass patency rate for all patients was 92 ± 7% at four years with no significant difference between the intra- and extrathoracic groups. At four years, 89 ± 9% of patients were free of symptoms and survival was 71 ± 10%.

Conclusion: Our results demonstrate that both intrathoracic and extrathoracic bypasses are equally durable and effective procedures for relieving symptoms due to brachiocephalic occlusive disease, although complication patters differ between the two procedures.

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Last updated January 1,2000