Journal «Angiology and Vascular Surgery» • 

2009 • VOLUME 15 • №4

Remote results of surgical treatment management for atherosclerotic lesions of the brachiocephalic trunk

Loenko V.B., Smyalovskii V.E., Dudarev V.E., Gubenko A.V., Tsekhanovich V.N.

Regional Clinical Hospital, Centre for Cardiovascular Surgery Clinical Diagnostic Centre, Omsk, Russia

Aim: optimization of diagnosis and surgical treatment of lesions of the brachiocephalic trunk (BCT) based on analysing the course of cerebrovascular disease in operated and nonoperated patients presenting with atherosclerotic lesions of the BCT.

Materials and methods. During the period form 1992 to 2008, we followed up a total of sixty-three patients presenting with atherosclerotic lesions of the BCT, who were subdivided into two subgroups: Subgroup One («surgical») was composed of the patients subjected to reconstructive operations on the BCT (n=25), and Subgroup Two («therapeutic») comprised nonoperated patients (n=38).

Results. Patients from Subgroup One underwent a total of 25 operations: twelve patients endured intrathoracic reconstruction with linear prosthetic repair of the BCT and the remaining thirteen sustained balloon-mediated dilatation of the BCT. Intraoperative restoration of the BCT's patency was achieved with all interventions. The reoentgenoendovascular operations were accompanied with no complication. In 2 cases (16.7%) prosthetic repair of the BCT was followed by thrombotic complications (1 – thrombosis of the BCT and 1 thrombosis of the stenosed ipsilateral vertebral artery) in the early postoperative period. During the follow-up period, patients of the surgical subgroup developed 3 strokes (12.0%), 3 myocardial infarctions (12.0%) and 1 sudden death (4.0%). Over the 5-year period, patients with the BCT lesions resulting from the natural course of cerebrovascular disease developed 14 ischaemic strokes (31.6% (χ2=26.4, p<0.0001), 5 (13.2%) myocardial infarctions (χ2=0.14, p=0.712), and 2 (5.3%) cases of sudden death. The relative risk of stroke in the therapeutic subgroup amounted to 32.6%. A decrease in the absolute risk of ischaemic stroke resulting from reconstruction of the BCT amounted to 24.8%. Hence, in order to prevent one stroke it is necessary to operate on four patients presenting with BCT lesions.

Conclusion. Reconstructive operations on the BCT are efficient in relation to prevention of ischaemic strokes. However, intrathoracic reconstructions were accompanied and followed by a relatively high level of complications. Therefore, it is necessary to use noninvasive methods of diagnosis to reveal patients presenting with BCT lesions at the stage of moderate stenoses and to subject them to preventive operation of balloon-mediated angioplasty.

KEY WORDS: atherosclerosis, brachiocephalic trunk, intrathoracic reconstruction, balloon-mediated dilatation, remote results, catamnesis.

P. 111-112

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