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THE JOURNAL OF CARDIOVASCULAR SURGERY

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The Journal of Cardiovascular Surgery 1999 February;40(1):15-20

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Transthoracic reconstructions of the innominate artery with atherosclerotic occlusions

Guirov K., Lazarov Z., Topalov I., Magaev B.

From the Clinic of Vascular Surgery and Angiology Military Medical Academy, Sofia, Bulgaria


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Back­ground. Lit­er­a­ture ­reports con­cerning trans­tho­racic recon­struc­tive oper­a­tions of the innom­i­nate ­artery (IA) are ­rare.
­Methods. Six men and one ­woman ­aged ­from 48 to 64 ­years ­were oper­ated on - all of ­them had ath­e­ros­cle­rotic IA ­lesions. ­Some of ­them had addi­tional vas­cular dis­ease ­such as cor­o­nary ath­e­ros­cle­rotic ­lesions in one ­patient, ­another one had ­chronic arte­rial ­ischemia (CM) of the ­lower extrem­ities and one ­patient under­went a ­stroke. All the ­patients had ­some neu­ro­log­ical symp­toms (head­ache, diz­zi­ness) and ­chronic arte­rial insuf­fi­ciency of the ­right arm, ­five ­patients had clin­i­cally and arte­ri­o­graph­i­cally ­detected sub­cla­vian ­steal syn­drome (SSS) ­with ver­teb­ro­bas­ilar symp­toms (­ataxia and syn­cops). Periph­eral arte­rial pres­sure (PAP) of ­both ­arms ­gave a dif­fer­ence ­from 30 to 80 ­mmHg. Aor­toar­ter­i­o-graphy ­showed one sten­osis and 6 throm­boses of the IA, the ­left ­common ­carotid ­artery (­LCCA) was ­affected in two ­cases. All oper­a­tions ­were ­done ­through a lon­gi­tu­dinal ster­notomy con­tinued by cer­vi­cotomy. In one ­patient an endar­te­rec­tomy (EA) of IA was ­done. In six ­patients a ­bypass oper­a­tion was performed. The ­ascending ­aorta was ­used for ­inflow. The ­distal anas­to­moses ­were ­with the ­distal ­part of the IA, in two ­patients, ­with the ­right sub­cla­vian ­artery (RSA) and the ­right ­common ­carotid ­artery (­RCCA) in two ­patients and ­with RSA, ­RCCA and ­LCCA in two ­cases.
­Results. ­There was no oper­a­tive or post­op­er­a­tive mor­tality, the post­op­er­a­tive com­pli­ca­tions ­were per­i­car­ditis and pneu­monia. The ­patients ­were ­observed for a ­period of 18 ­months to 10 ­years. The use of Dop­pler-con­trol pro­vided ­patency ­data of arte­rial ­grafts in all the ­patients. One ­patient ­died of a ­heart ­attack ­five ­years ­after sur­gery, ­another had an ­ischemic ­stroke of the ­left hem­i­sphere ­four ­years ­after sur­gery.
Con­clu­sions. The ­authors con­sider ­that trans­tho­racic IA recon­struc­tions, ­although ­being trau­matic, ­give ­good ­early and ­long-­term ­results.

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