[Extrathoracic versus transthoracic methods of surgical correction of stenoses and occlusions of the aortic arch branches: a comparison]

Abstract

125 reconstructions performed during the years 1968 to 1988 were analysed retrospectively. 81 surgical procedures were extrathoracic (64.8%) and 44 transthoracic (35.2%). The symptoms of the aortic arch branch lesions included subclavian steal syndrome in 67 (53.6%), transient cerebral ischemia in 16 (12.8%), residua of cerebral infarction in 5 (4.0%), monocular ischemic attacks in 16 (12.8%) and ischemic arm symptoms in 27 (21.6%) patients. Surgical repair was achieved by subclavian-carotid transposition in 44 (35.2%), carotid-subclavian bypass in 23 (18.4%), carotid-subclavian transposition in 2 (1.6%), endarterectomy of the subclavian artery in 5 (4.0%), carotid-carotid bypass in 3 (2.4%), subclavian-subclavian bypass in 4 (3.2%), aorto-subclavian bypass in 9 (7.2%), endarterectomy of the left subclavian artery in 18 (14.4%) and reconstruction of the innominate artery in 17 (13.6%) patients. 124 patients had complete remission of symptoms or at least showed marked improvement postoperatively. The overall patency rate of the extra- and transthoracic procedures in 85% at an average follow-up of 115 months. The patency rate in the extrathoracic group is 82% and not significantly lower than in the transthoracic group with a patency rate of 89%.