Surgical management of obliterative disease of the brachiocephalic trunk. Experience from 24 cases.

Transsternal endarterectomy was performed in 24 patients for symptomatic obliterative disease of the brachiocephalic trunk in the period 1961-1981. In 10 of the patients the vessel was occluded, and in 14 there were various degrees of stenosis. Reversal of vertebral artery flow was found in 15 patients. Subclavian steal-carotid recovery phenomenon was present in six patients, and one patient had reversed flow in both the right vertebral and the common carotid artery. Only 10 of the 24 patients were free from obliterative changes in other extracranial arteries. After the reconstruction, the blood flow in the brachiocephalic trunk increased from 370 to 610 ml/min in patients with stenosis, and from 0 to 692 ml/min in patients with occlusion. The flow rate changed in the right vertebral artery from -58 to + 119 ml/min and in the right common carotid artery from 116 to 340 ml/min. Two patients died in the early postoperative period (8.5%) and six died during the follow-up period. Follow-up was possible in 21 patients. The result of endarterectomy was assessed as cure in 14, improvement in two and failure in three patients. Stroke occurred in two patients.