Alternatives in the management of atherosclerotic occlusive disease of aortic arch branches.

Abstract

The cases of 62 patients with atherosclerotic occlusive disease at the origin of the aortic arch branches were reviewed. Thirty-six were initially without neurologic symptoms and in four (11%) intermittent neurologic symptoms without stroke developed during an average follow-up of 27 months. No patient had limb-threatening ischemia. Twenty-six operations were performed for neurologic symptoms or disabling limb ischemia, with one death. Five-year graft patency by life-table analysis was 81%. Preoperative or late postoperative stroke in three patients with occluded common carotid artery suggests this to be a more dangerous subgroup. We advise surgery for patients with disabling arm symptoms or with ischemic neurologic symptoms associated with multiple-vessel disease or with major lesions in the innominate-carotid circulation. We advocate selective revascularization with priority given to the innominate-carotid flow, isolated subclavian lesions first seen as a single lesion or as the only residual lesion after reconstruction for multiple-vessel disease can be safely left unreconstructed.