Aortic Arch Syndrome (Brachiocephalic Ischemia)

¹ Department of Surgery, Ochsner Clinic

Occlusion of the great vessels as they arise from the aortic arch has been designated in a variety of ways to describe the clinical manifestations, anatomic or pathologic alterations, etiologic factors, or the name of a person associated with the condition. Brachiocephalic ischemia best describes the result of obstruction of the branches of the aortic arch.

The exact clinical manifestations depend on the cause and anatomic distribution of the occlusive process, the coexistent systemic manifestations of the disease, and the status of the collateral circulation. It is not surprising, therefore, that the symptoms and course of brachiocephalic ischemia are extremely variable. Transient episodes of cerebral ischemia are produced, and it is mandatory to recognize these warning signs so that surgical treatment can be instituted before irreversible damage occurs.

Surgical treatment is accomplished by bypass graft or thromboendarterectomy, with or without patch graft. Selection of the type and extent of surgical reconstruction must be individualized, and determined by the severity of symptoms, anatomic and pathologic nature of the disease, and physiologic status of the patient.