The Annals of Thoracic Surgery, Vol 47, 580-585, Copyright © 1989 by The Society of Thoracic Surgeons
Extrathoracic and transthoracic management of vascular disease of the aortic arch branches: a 16-year experience
C Farina, AV Sterpetti, RD Schultz, RJ Feldhaus and K Davenport
Department of Surgery, Creighton University, Omaha, Nebraska.
To determine factors influencing results of operation for proximal
brachiocephalic arterial disease, a 16-year review of 74 consecutive
patients was undertaken. A total of 62 subclavian, 14 common carotid, 6
innominate, and 2 vertebral arteries were revascularized during 79
procedures. The approach was transthoracic in 12 operations and
extrathoracic in 67. Mean follow-up was 57 +/- 45 months. Two patients
(2.5%) died of stroke after extrathoracic revascularization of the common
carotid artery. Cumulative 5-year and 10-year freedom from neurological
events was 81% and 75%, respectively. The best results were obtained with
transthoracic procedures, with revascularization of the subclavian artery
rather than the common carotid artery, and in operations performed in
patients without associated distal carotid disease. In view of the recent
progress in operative techniques and postoperative surgical care, the
choice between the transthoracic approach and the extrathoracic approach
should not be biased; rather, they should remain equal and viable
alternatives based on anatomical and clinical features of the individual
patients.
