title: Open reconstructions for symptomatic atherosclerotic lesions of the supra-aortic vessels: thirty years results from two university hospitals.
abstract: BACKGROUND
  Atherosclerotic lesions at the origin of common carotid, subclavian, and innominate arteries are causes for brain and hand ischemic symptoms. Surgical reconstructions of symptomatic cases remain the golden standard treatment, although the endovascular approach has been promising as well. In this retrospective study, long-term results of open reconstructions from 2 University Hospitals are presented.
  
  
  METHODS
  Through a 30-year period, prospective data of 107 patients, suffering from symptomatic atherosclerotic supra-aortic artery disease, were retrospectively reviewed and included in this study. Demographic data, arterial risk factors, presenting symptoms and signs, diagnostic evaluation, operative treatment and complications, resolution of symptoms, redo surgery, and overall mortality were analyzed.
  
  
  RESULTS
  Eighty-one patients were operated on for subclavian, 14 for innominate, and 12 for common carotid severe lesions, through an extra-thoracic reconstruction (91 patients) or a transthoracic one (16 patients). Perioperative mortality was null although morbidity was 16.8%, and primary perioperative patency was 97.2% (secondary patency 100%). The cumulative primary patency was 95.3%, 90.7%, and 86.0% at 5, 10, and 15 years, respectively. The mean time of patency was 214.6 months (95% confidence interval = 198.5-230.6), with no difference between transthoracic and extrathoracic reconstructions (P = 0.278).
  
  
  CONCLUSIONS
  Open reconstructions remain a therapeutic strategy with a considerably low perioperative morbidity/mortality offering excellent long-term results regarding patency of the reconstructions and clinical resolution of the symptoms. However, in the modern era of the endovascular techniques, we need more studies for establishing anatomic and clinical criteria regarding patient selection for endovascular angioplasty/stenting or open repair.
authors.affiliation: Vascular Surgery Division, First Department of Propaedeutic Surgery, Hippokration Hospital, National & Kapodistrian University of Athens, Athens, Greece.
authors.forename: Fragiska
authors.initials: F
authors.lastname: Sigala
authors.affiliation: Vascular Surgery Division, First Department of Propaedeutic Surgery, Hippokration Hospital, National & Kapodistrian University of Athens, Athens, Greece. Electronic address: georgegalyfos@hotmail.com.
authors.forename: George
authors.initials: G
authors.lastname: Galyfos
authors.affiliation: Department of Vascular Surgery, St. Joseph Hospital, Haan, Germany.
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Coutelle
authors.affiliation: Vascular Surgery Division, First Department of Propaedeutic Surgery, Hippokration Hospital, National & Kapodistrian University of Athens, Athens, Greece.
authors.forename: Pantelis
authors.initials: P
authors.lastname: Antonakis
authors.affiliation: Vascular Surgery Division, First Department of Surgery, Laiko Hospital, National & Kapodistrian University of Athens, Athens, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Sigalas
authors.affiliation: Vascular Surgery Division, First Department of Surgery, Laiko Hospital, National & Kapodistrian University of Athens, Athens, Greece.
authors.forename: Elias
authors.initials: E
authors.lastname: Bastounis
authors.affiliation: Department of Vascular Surgery, St. Joseph Hospital, Haan, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hepp
authors.affiliation: Vascular Surgery Division, First Department of Propaedeutic Surgery, Hippokration Hospital, National & Kapodistrian University of Athens, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Filis
mesh_terms: D000328:Adult; D000368:Aged; D050197:Atherosclerosis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016122:Brachiocephalic Trunk / Q000503:physiopathology / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017536:Carotid Artery, Common / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005858:Germany; D006115:Greece; D006785:Hospitals, University; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013348:Subclavian Artery / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency