[Vascular stenosis of the branches of the aortic arch. Surgical treatment and long-term follow-up].

Since 1971 69 patients have been operated on for lesions of branches of the aortic arch (71 surgical procedures). In 80% of the patients extrathoracic reconstructions were performed, mainly carotid-subclavian bypasses (64%) using knitted dacron grafts (6 mm and 8 mm diameter). A transthoracic approach was used in 20% of the patients. No patient died after operation and no ischemic neurological deficit occurred. The cumulative survival rate was 89% after five and 59% after ten years. The cumulative patency rate in the survivors was 100% after transthoracic approach after five and ten years. Identical patency rates were observed after extrathoracic carotid-subclavian bypass using 8 mm dacron grafts, whereas in 6 mm grafts the patency rate was only 67% after five and ten years. 85% of all patients were symptom-free and additional 10% improved. These results confirm that carotid-subclavian bypass using 8 mm dacron grafts has a long term patency rate identical to those after anatomical transthoracic procedures.