Extrathoracic management of aortic arch syndrome

Criado, Frank J.

doi:10.1002/bjs.1800691316

Cited by 43 publications

(8 citation statements)

References 46 publications

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“…12 When a formal bypass graft is performed, graft material does appear to affect long-term patency with prosthetic conduits performing superiorly to saphenous vein grafts. 29 In one series, two of six saphenous vein CSB grafts occluded within the first year, whereas all nine Dacron grafts remained patent in follow-up that extended to 97 months. 9 In the largest series of saphenous vein CSB grafts in the literature, 11% of 36 saphenous vein grafts thrombosed with a mean follow-up of 52 months.…”

Section: Discussionmentioning

confidence: 94%

Carotid-subclavian bypass—A decade of experience

Perler

Williams

1990

Journal of Vascular Surgery

102

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From August 1979 to August 1989, carotid-subclavian bypass or transposition procedures were performed on 18 women and 13 men ranging in age from 19 to 75 (mean, 58.2) years. Indications for surgery included symptoms of vertebrobasilar insufficiency in 16 (52%), upper extremity ischemia in six (19%), both vertebrobasilar insufficiency and extremity ischemia in four (13%), and stroke and/or hemispheric transient ischemic attacks in four (13%) patients. One patient (3%) had angina pectoris caused by "coronary-subclavian steal." Formal bypass grafts were performed in 28 (90%) cases by means of polyterafluoroethylene (24), Dacron (2), or saphenous vein (2), and carotid-subclavian transposition was performed in three (10%) cases. Synchronous procedures included carotid endarterectomy (4), carotid-carotid bypass (1), and axillobrachial bypass (1). There was no operative mortality. Thirty-day primary patency was 97%. Follow-up has ranged from 1 to 121 (mean, 42) months. Three grafts (polytetrafluoroethylene) have occluded during follow-up yielding long-term primary patency of 92% at 5 years and 83% at 8 years. Relief of symptoms was initially achieved in 30 (97%) patients. Recurrent symptoms have developed in six (20%) patients from 2 to 55 (mean, 26) months after surgery, including two with occluded and four with patent grafts. Symptom-free survival is 89% at 1 year, 84% at 2 years, and 71% at 7 years of follow-up. Six patients have died during follow-up yielding overall survival of 88% at 5 years, and 48% at 10 years.(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Discussionmentioning

confidence: 94%

Carotid-subclavian bypass—A decade of experience

Perler

Williams

1990

Journal of Vascular Surgery

102

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“…Among these deeply placed bypasses we have not encountered any prosthetic infections as have been reported in some pretracheal prosthesis crossing the neck. 7 Finally, retropharyngeal prosthesis do not interfere with a tracheostomy or with a midsternotomy, which may be needed later for a myocardial revascularization.…”

Section: Discussionmentioning

confidence: 99%

Revascularization by the retropharyngeal route for extensive disease of the extracranial arteries

Berguer

González

1994

Journal of Vascular Surgery

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This is a retrospective study of 16 patients who had an average of 3.25 arteries supplying the brain that were occluded or severely diseased. In all of them severe disease or occlusion of the left carotid and subclavian arteries precluded an ipsilateral repair. Methods: These patients with extensive extracranial arterial disease underwent revascularization from the opposite side of the neck through a retropharyngeal tunnel. Twelve patients had contraindications for a transthoracic repair. Results: There were no early deaths. Postoperative complications included one graft occlusion, one anastomotic disruption with hemorrhage, and one stroke, all resulting from management errors. Follow-up was 100%. Primary patency rate was 94%, and survival was 87.5%. Two patients died in the interval: one from a myocardial infarction and one from cause unknown. Conclusions: The retropharyngeal route is a shorter and more direct path across the neck and occasionally permits direct carotid-to-carotid transposition without the use of prosthetic bypasses. Even in the presence of extensive extracranial disease, these reconstructions have an excellent patency rate, and these patients have a survival 87.5% after a mean follow-up of 5.56 ± 4.0 years.

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“…While extrathoracic methods are the preferred procedures for most isolated lesions of the intrathorack great vessels, most would agree that multiple lesions and/or innominate artery occlusion are best treated using direct reconstruction via either transthoracic endarterectomy or bypass operations. 3,6,[7][8][9] In neither of our cases was endarterectomy a feasible procedure and therefore transthoracic bypasses were performed. The use of an 8 nun T-piece graft allows the proximal limb (anastomosed to the ascending aorta) to sit comfortably under the sternum.…”

Section: Discussionmentioning

confidence: 99%

Brachio‐cephalic Revascularization From the Intrathoracic Aorta: Use of a T‐piece Graft

Bourke

Greenhalgh

1985

Australian and New Zealand Journal of Surgery

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Ready made T‐piece dacron grafts have been available for some time for use in axillo‐bifemoral procedures. This report illustrates the use of such a graft in two cases of brachiocephalic revascularization from the intrathoracic aorta. In each case the aortic arch branches were severely diseased. The technique allows placement of the 8 mm diameter limb on the ascending aorta deep to the sternum, where, because of its lack of bulk, it can sit without compression. The 8 mm side piece can be manoeuvred to follow any direction required and avoids placement of an anastomosis in an otherwise awkward area. If required, a third limb can be sutured onto the proximal limb beyond the region where compression would occur.

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Extrathoracic management of aortic arch syndrome

Cited by 43 publications

References 46 publications

Carotid-subclavian bypass—A decade of experience

Carotid-subclavian bypass—A decade of experience

Revascularization by the retropharyngeal route for extensive disease of the extracranial arteries

Brachio‐cephalic Revascularization From the Intrathoracic Aorta: Use of a T‐piece Graft

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