Avtor/Urednik		Takach, Thomas J; Reul, George J; Cooley, Denton A; Duncan, J Michael; Livesay, James J; Gregorič, Igor D; Krajcer, Zvonimir; Cervera, Roberto D; Ott, David A; Frazier, OH
Naslov		Brachiocephalic reconstruction I: operative and long-term results for complex disease
Tip		članek
Vir		J Vasc Surg
Vol. in št.		Letnik 42, št. 1
Leto izdaje		2005
Obseg		str. 47-54
Jezik		eng
Abstrakt		Objectives: Complex brachiocephalic disease involves multiple vessels and is frequently associated with multisystem atherosclerosis. We reviewed surgical outcome and examined the impact of this problem on decision making regarding operative staging, technique, and choice of conduit. Methods: Between 1966 and 2000, 157 consecutive patients (mean age, 54.0 years; 48.4% male) with innominate artery or multivessel brachiocephalic disease underwent operative reconstruction using either a transthoracic approach (group A, n = 113) or a less invasive, extrathoracic approach (group B, n = 44). Reconstruction required multiple distal anastomoses in 70 patients (44.6%), concomitant coronary artery bypass grafting (CABG) in 37 patients (23.6%), and concomitant carotid endarterectomy (CEA) in 26 patients (16.6%). Results: No significant differences were found between group A and group B when operative mortality (2.7% vs 2.3%) and stroke rates (2.7% vs 6.8%) were analyzed. However, 10 years after surgery, freedom from graft failure was significantly better in group A (94.4% +/- 4.4%) than in group B (60.3% +/- 13.4%) ( P = .002). Freedom from graft failure was adversely affected by nonaortic inflow ( P = .002) and axillo-axillary cervical grafts ( P = .0001). Mortality and stroke rates for subgroups having multiple distal anastomoses (2.9%, 2/70 and 4.3%, 3/70), concomitant CABG (5.4%, 2/37 and 0, 0/37), and concomitant CEA (3.8%, 1/26 and 3.8%, 1/26) were similar to those of other patients. For the entire patient group, 10-year rates of actuarial freedom from specific events were death, 68.8% +/- 6.0%; myocardial infarction, 86.7% +/- 4.5%; stroke, 87.0% +/- 4.4%; coronary revascularization, 88.0% +/- 3.6%, and other vascular operation, 79.9% +/- 4.4%. (Abstra truncated at 2000 characters)
Deskriptorji		BRACHIOCEPHALIC TRUNK BRACHIOCEPHALIC VEINS ADULT AGED AGED, 80 AND OVER ARTERIOSCLEROSIS COMORBIDITY CORONARY ARTERY BYPASS ENDARTERECTOMY, CAROTID RETROSPECTIVE STUDIES TREATMENT OUTCOME VASCULAR DISEASES