Brachiocephalic reconstruction
Indications for diagnostic workup
[edit | edit source]- Vertebrobasilar insufficiency
- Vertigo, ataxia, binocular visual symptoms, drop attacks
- Subclavian steal syndrome
- Vertebrobasilar insufficiency associated with arm exercise
- Reversal of flow in vertebral artery on duplex USS
- Upper extremity ischaemia
- Absent/diminished/asymmetric pulses, limb fatigue
- Embolic complications
- Ulcers or non-healing wounds of digits
- Aneurysmal disease (e.g. right subclavian aneurysm)
Diagnostic workup
[edit | edit source]- Duplex USS first-line
- Carotids, vertebrals
- CTA/MRA
Indications for treatment
[edit | edit source]- Not well-defined
- Classic hemispheric symptoms with corresponding lesion
- Upper extremity ischaemic symptoms with subclavian artery lesions
- Treatment for asymptomatic patients is controversial, to say the least
- Non-lateralising symptoms need thorough consideration
- Inflammatory arteritis (takayasu's) the initial acute phase should be treated medically, with surgery reserved for persisting stenoses