Thrombo-obliterative disease of the branches of the aortic arch causes symptoms of ischemia in the head and upper extremities. In the two cases here described it was sharply delimited. In the first case its location was determined with the help of aortography; in the second, the physical findings with usual chest roentgenograms sufficed. In the first case two incisions in the neck were needed to settle the diagnosis and to permit thromboendarterectomy at the level of the carotid sinus; in addition, a right anterior thoracotomy in the second interspace was needed, and a bifurcated nylon tube was inserted to lead from the aorta past the obstructed brachiocephalic trunk to the right subclavian and common caratid arteries. In the second case an obstruction involving the left subclavian artery was removed by thromboendarterectomy. Normal pulsations reappeared in the arteries distal to the site of operation in each case. Both patients were relieved of symptoms and were able to return to work.
De Bakey ME, Morris GC, Jordan GL, Cooley DA. SEGMENTAL THROMBO-OBLITERATIVE DISEASE OF BRANCHES OF AORTIC ARCH: SUCCESSFUL SURGICAL TREATMENT. JAMA. 1958;166(9):998–1003. doi:10.1001/jama.1958.02990090006002
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