Author/Editor     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
Title     Brachiocephalic reconstruction I: operative and long-term results for complex disease
Type     članek
Source     J Vasc Surg
Vol. and No.     Letnik 42, št. 1
Publication year     2005
Volume     str. 47-54
Language     eng
Abstract     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)
Descriptors     BRACHIOCEPHALIC TRUNK
BRACHIOCEPHALIC VEINS
ADULT
AGED
AGED, 80 AND OVER
ARTERIOSCLEROSIS
COMORBIDITY
CORONARY ARTERY BYPASS
ENDARTERECTOMY, CAROTID
RETROSPECTIVE STUDIES
TREATMENT OUTCOME
VASCULAR DISEASES