Long-term results of aortoinnominate and aortocarotid polytetrafluoroethylene bypass grafting for atherosclerotic lesions.

Abstract

Between January 1978 and December 1986, 69 polytetrafluoroethylene bypass grafts on the ascending aorta were placed in 53 patients with atherosclerotic occlusive disease of the innominate and left common carotid arteries. Thirty-six patients had symptoms predominantly of amaurosis fugax, verebrobasilar ischemia, and upper limb ischemia. The remaining 17 patients had no symptoms but had severe hemodynamically significant occlusive disease. All operations were accomplished via median sternotomy. One patient died after surgery (operative mortality rate 1.9%), and one patient had minor postoperative neurologic deficit that partially improved on long-term follow-up. Patency of the reconstruction was routinely assessed by a Doppler device combining (1) a continuous wave Doppler and (2) real-time mechanical sector B-mode imaging with frequencies of 3.5 MHz and 7.5 MHz. There were two early asymptomatic occlusions; one was related to a technical error that was successfully revised and the other to low systemic perfusion. The mean follow-up time was 50.5 months. Two patients were lost to follow-up and a further six patients died, for a cumulative 5-year survival rate of 84.9%. One patient had only partial improvement in symptoms and one patient sustained a late postoperative neurologic deficit after internal carotid occlusion distal to a patent aortocarotid bypass. The remaining patients were free of symptoms. There were no infective complications. All the patients underwent late assessment by Doppler ultrasonography and B-mode scanning. One asymptomatic occlusion was thereby identified to be a result of diminished runoff. The overall secondary patency rate at 5 years was 96.1%.(ABSTRACT TRUNCATED AT 250 WORDS)