Aortobrachiocephalic reconstruction.

Aortobrachiocephalic reconstruction was studied in 26 patients. Nine had suffered a previous stroke, and seven had residual deficity. A previous carotid endarterectomy or carotid-to-subclavian bypass had been performed in eight patients. The ascending aorta was the proximal anastomotic site in all cases. Bypass grafting to a single distal site was performed in 11 patients (42 percent), to 2 distal sites in 14 patients (54 percent) and to 3 distal sites in 1 patient (4 percent). The carotid artery, innominate arteries, or both were involved in all reconstructions. Concomitant carotid or subclavian endarterectomy was performed in 14 patients, 1 of whom also had a coronary bypass at the same time. Two patients (7 percent) died in the postoperative period. Twenty-three of 24 survivors (96 percent) had relief of symptoms after operation. Only one patient had worsening of symptoms postoperatively, which was secondary to intracerebral hemorrhage. Results of this study indicate that direct revascularization of the arch branches can be carried out with minimal morbidity and mortality. Relief of presenting symptoms is to be expected, and long-term results suggest that the operation is durable.