SURGICAL TREATMENT OF LESIONS PRODUCING ARTERIAL INSUFFICIENCY OF THE INTERNAL CAROTID, COMMON CAROTID, VERTEBRAL, INNOMINATE AND SUBCLAVIAN ARTERIES

Abstract

In a consecutive series of 305 patients with manifestations of arterial insufficiency of the cerebrum and upper extremities, arteriography revealed the presence of extracranial arterial occlusion in 122. Of this latter number, 106 were submitted to operation, 93 of whom were found to have occlusive lesions that were segmental in character permitting reconstructive surgical procedures. Since multiple lesions were present in approximately one half the cases, there was a total of 136 segmental occlusive lesions in this group of operable cases. Atherosclerosis was the underlying cause of these lesions. In general, this disease seems to assume two characteristic patterns, a proximal form in which the occlusive lesions involve the great vessels arising from the aortic arch and a distal form in which the occlusive process involves the carotid arteries at their bifurcation and the vertebral arteries near their origin from the subclavian arteries. All the proximal forms of occlusions, whether complete or incomplete, were segmental in nature and therefore operable. In the distal form of the disease all of the incomplete occlusive lesions were operable but only a small proportion of those with complete occlusions were operable. Two types of surgical procedure were employed, namely thromboendarterectomy for discrete, well-localized lesions and the bypass graft for more extensive lesions. Pulsatile circulation was restored in 82 of the 85 lesions in which the former procedure was applied and in all of the 51 lesions in which the latter procedure was employed. Normal circulation was also successfully restored in all of the proximal occlusive lesions, in 97% of those with operable lesions of the internal carotid artery and in 66% of those involving the vertebral artery.