[Supra-aortic trunks occlusive disease: three different treatment approaches].
Unlike carotid bifurcation atherosclerotic stenosis, supra-aortic trunks (SAT) occlusive disease is rare and its revascularization uncommon, accouting for less than 10% of the operations performed on the extracranial brain-irrigating arteries. There are three different treatment approaches: transthoracic, extra-anatomic cervical and endovascular. Endovascular repair is gaining popularity as first-line therapy for proximal lesions with favorable anatomy because of its low morbidity and rare mortality. Extra-anatomic bypass is a safe and durable reconstruction and should be considered in patients with single vessel disease, with cardiopulmonary high-risk or with limited life expectancy. If cardiac surgery is needed, central transthoracic reconstruction is preferable, and the two procedures should be combined. The long-term patency of bypasses with aortic origin, specially when multiple vessels are involved, is superior to other repair techniques. We present three clinical cases that illustrate each of these therapeutic strategies: central brachiocephalic revascularization and synchronous cardiac surgery in a patient with complex SAT atherosclerosis disease; subclavian-carotid transposition for disabling upper limb claudication; and subclavian artery stenting for subclavian-steal syndrome. Surgical approach selection should be based on the individual patient's anatomy and operative risk.
Serviço de Angiologia e Cirurgia Vascular e Centro de Cirurgia Torácica do Hospital de S. João, Porto; Unidade de IeD Cardiovascular, Faculdade de Medicina da Universidade do Porto.
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Dias
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Almeida
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Sampaio
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Silva
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Leite-Moreira
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Pinho
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Roncon de Albuquerque
D000328:Adult; D000368:Aged; D001018:Aortic Diseases / Q000473:pathology / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000473:pathology / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D015607:Stents; D013348:Subclavian Artery / Q000601:surgery; D013349:Subclavian Steal Syndrome / Q000473:pathology / Q000601:surgery; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*