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Complex Cerebral Revascularization

Complex Cerebral Revascularization Abstract • Although carotid endarterectomy is the usual technique for treating symptoms related to extracranial arterial occlusive disease, cerebrovascular and upper extremity symptoms caused by lesions of the innominate, common carotid, or subclavian orifices necessitate more complex revascularization techniques. We have treated five patients, three females and two males, with symptoms of cerebrovascular and/or upper extremity ischemia by highly individualized, complex, revascularization techniques. The procedures were amalgamations of carotid-subclavian bypass, carotid-subclavian bypass with carotid bifurcation endarterectomy, subclavian-subclavian bypass, axillo-axillary bypass, and carotid-axillary bypass. The conditions of all patients were greatly improved and four of the five patients became asymptomatic. These procedures seem to be highly effective in relieving symptoms and they minimize the risks of cerebral and upper extremity revascularization. (Arch Surg 113:706-709, 1978) References 1. DeBakey ME, Morris GC Jr, Jordan GL Jr, et al: Segmental thromboobliterative disease of branches of aortic arch . JAMA 166:988-993, 1958. 2. DeBakey ME, Crawford ES, Cooley DA, et al: Surgical considerations of occlusive disease of innominate, carotid, subclavian, and vertebral arteries . Ann Surg 149:690-710, 1958.Crossref 3. Crawford ES, DeBakey ME, Morris GC Jr, et al: Surgical treatment of occlusion of the innominate, common carotid, and subclavian arteries: A ten-year experience . Surgery 65:17-31, 1969. 4. Diethrich EB, Garrett HE, Ameriso J, et al: Occlusive disease of the common carotid and subclavian arteries treated by carotid-subclavian bypass- analysis of 125 cases . Am J Surg 114:800-808, 1967.Crossref 5. Najafi H, Dye WS, Javid H, et al: Carotid bifurcation stenosis and ipsilateral subclavian steel . Arch Surg 99:289-292, 1969.Crossref 6. Finkelstein NM, Byer A, Rush BF Jr: Subclavian-subclavian bypass for the subclavian steal syndrome . Surgery 71:142-145, 1972. 7. Mozersky DJ, Sumner DS, Barnes RW, et al: Subclavian revascularization by means of a subcutaneous axillary-axillary graft . Arch Surg 106:20-23, 1973.Crossref 8. Dardik H, Dardik I: Axillo-axillary bypass with cephalic vein for correction of subclavian steal syndrome . Surgery 76:413-418, 1975. 9. Bergan JJ, Dean RH, Yao JST: Use of the axillary artery in complex cerebral revascularization . Surgery 77:338-344, 1975. 10. Ehrenfeld WK, Levin SM, Wylie EJ: Venous crossover bypass grafts for arterial insufficiency . Ann Surg 167:287-291, 1968.Crossref 11. Shumacker HB Jr: Carotid axillary bypass grafts for occlusion of the proximal portion of the subclavian artery . Surg Gynecol Obstet 136:447-448, 1973. 12. Pierandozzi JS, Ingala A, Cowen SZ: Proximal subclavian artery occlusion: The retroclavicular common carotid axillary bypass . Arch Surg 110:126-127, 1975.Crossref 13. Kartchner MM, McRae LP, Crain V, et al: Oculoplethysmography: An adjunct to arteriography in the diagnosis of extracranial carotid occlusive disease . Am J Surg 132:728-732, 1976.Crossref 14. Gee W, Oiler DW, Wylie EJ: Noninvasive diagnosis of carotid occlusion by ocular pneumoplethysmography . Stroke 7:18-21, 1976.Crossref 15. Moore WS, Malone JM, Goldstone J: Extrathoracic repair of branch occlusions of the aortic arch . Am J Surg 132:249-258, 1976.Crossref 16. Shumacker HB Jr, Isch JH, Jolly WW, et al: The management of stenotic and obstructive lesions of the aortic arch branches . Am J Surg 133:351-360, 1977.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

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References (18)

Publisher
American Medical Association
Copyright
Copyright © 1978 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1978.01370180048005
Publisher site
See Article on Publisher Site

Abstract

Abstract • Although carotid endarterectomy is the usual technique for treating symptoms related to extracranial arterial occlusive disease, cerebrovascular and upper extremity symptoms caused by lesions of the innominate, common carotid, or subclavian orifices necessitate more complex revascularization techniques. We have treated five patients, three females and two males, with symptoms of cerebrovascular and/or upper extremity ischemia by highly individualized, complex, revascularization techniques. The procedures were amalgamations of carotid-subclavian bypass, carotid-subclavian bypass with carotid bifurcation endarterectomy, subclavian-subclavian bypass, axillo-axillary bypass, and carotid-axillary bypass. The conditions of all patients were greatly improved and four of the five patients became asymptomatic. These procedures seem to be highly effective in relieving symptoms and they minimize the risks of cerebral and upper extremity revascularization. (Arch Surg 113:706-709, 1978) References 1. DeBakey ME, Morris GC Jr, Jordan GL Jr, et al: Segmental thromboobliterative disease of branches of aortic arch . JAMA 166:988-993, 1958. 2. DeBakey ME, Crawford ES, Cooley DA, et al: Surgical considerations of occlusive disease of innominate, carotid, subclavian, and vertebral arteries . Ann Surg 149:690-710, 1958.Crossref 3. Crawford ES, DeBakey ME, Morris GC Jr, et al: Surgical treatment of occlusion of the innominate, common carotid, and subclavian arteries: A ten-year experience . Surgery 65:17-31, 1969. 4. Diethrich EB, Garrett HE, Ameriso J, et al: Occlusive disease of the common carotid and subclavian arteries treated by carotid-subclavian bypass- analysis of 125 cases . Am J Surg 114:800-808, 1967.Crossref 5. Najafi H, Dye WS, Javid H, et al: Carotid bifurcation stenosis and ipsilateral subclavian steel . Arch Surg 99:289-292, 1969.Crossref 6. Finkelstein NM, Byer A, Rush BF Jr: Subclavian-subclavian bypass for the subclavian steal syndrome . Surgery 71:142-145, 1972. 7. Mozersky DJ, Sumner DS, Barnes RW, et al: Subclavian revascularization by means of a subcutaneous axillary-axillary graft . Arch Surg 106:20-23, 1973.Crossref 8. Dardik H, Dardik I: Axillo-axillary bypass with cephalic vein for correction of subclavian steal syndrome . Surgery 76:413-418, 1975. 9. Bergan JJ, Dean RH, Yao JST: Use of the axillary artery in complex cerebral revascularization . Surgery 77:338-344, 1975. 10. Ehrenfeld WK, Levin SM, Wylie EJ: Venous crossover bypass grafts for arterial insufficiency . Ann Surg 167:287-291, 1968.Crossref 11. Shumacker HB Jr: Carotid axillary bypass grafts for occlusion of the proximal portion of the subclavian artery . Surg Gynecol Obstet 136:447-448, 1973. 12. Pierandozzi JS, Ingala A, Cowen SZ: Proximal subclavian artery occlusion: The retroclavicular common carotid axillary bypass . Arch Surg 110:126-127, 1975.Crossref 13. Kartchner MM, McRae LP, Crain V, et al: Oculoplethysmography: An adjunct to arteriography in the diagnosis of extracranial carotid occlusive disease . Am J Surg 132:728-732, 1976.Crossref 14. Gee W, Oiler DW, Wylie EJ: Noninvasive diagnosis of carotid occlusion by ocular pneumoplethysmography . Stroke 7:18-21, 1976.Crossref 15. Moore WS, Malone JM, Goldstone J: Extrathoracic repair of branch occlusions of the aortic arch . Am J Surg 132:249-258, 1976.Crossref 16. Shumacker HB Jr, Isch JH, Jolly WW, et al: The management of stenotic and obstructive lesions of the aortic arch branches . Am J Surg 133:351-360, 1977.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Jun 1, 1978

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