Occlusion of the innominate, common carotid, and subclavian arteries: long-term results of surgical treatment.

During the 23-year period from January 1959 to February 1982, 142 patients (78 men and 64 women) underwent arterial reconstructive operations for obstruction of the brachiocephalic arteries. A single vessel was involved in 75% and multiple vessels were involved in 25% of the cases. Distal involvement of internal carotid and vertebral arteries was present in 58 (41%) patients. Transthoracic operation was performed in 43 (31%) and extrathoracic operation was performed in 99 (69%) patients. One hundred and thirty-nine patients (98%) survived, and 134 (94%) experienced relief of symptoms. Follow-up was obtained for 136 patients for periods up to 22 years (mean of 7.5 years). Of these, 113 patients remained asymptomatic, eight developed transient strokes, four developed persistent strokes, and 11 (8%) died of stroke. The mean interval after operation in the latter cases was 9.3 years. Survival rates at 5, 10, and 15 years were 85%, 58%, and 25%, respectively.