Complex Cerebral Revascularization

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.