Arterial reconstruction of the brachiocephalic trunk and the subclavian arteries. 10 years' experience with a follow-up study

During a 10-year period, 60 patients were operated on for occlusive lesions in the brachiocephalic trunk and/or the subclavian arteries proximal to the vertebral artery. Angiography showed 68 occlusive lesions, of which 64 were treated surgically. Of these, 47 exhibited subclavian steal. Sixty-three reconstructive procedures were performed together with two arterial ligations (four patients were operated on bilaterally and one patient was operated on twice on the same side). There were 30 transthoracic procedures, essentially endarterectomies, and 35 supraclavicular procedures, mostly carotid-subclavian bypasses and transpositions of the subclavian artery to the common carotid artery. One patient died (1.5 per cent). Serious complications occurred in additional four cases. In the follow-up study data on all the patients were available. During the follow-up period, ranging from four to 124 months (mean 43 months) seven patients died - none of cerebral ischemia. Based on blood pressure recordings and in doubtful cases, angiography, we found a cumulated five-year patency rate of 76 per cent. Seventy per cent of the patients considered their condition after operation to be improved, 26 per cent unchanged and three per cent worsened. Twice as many patients could work after the operation as before. The cumulative survival rate was found to be somewhat lower than that of a normal population.