Chronic occlusion of aortic arch branches.

Partial or complete occlusion of aortic arch branches has commonly been considered a single entity,9 though it is readily subdivided into a number of distinct types. The classical variety, an idiopathic arteritis (Takayasu’s disease or “pulseless disease”) which occurs in young women is quite rare.1 Occlusions resulting from arteriosclerosis obliterans,2 thoracic outlet syndrome,’4 embolus, aneurysm, dissecting aneurysm, syphilis, Buerger’s disease, neoplasm, and thrombocytosis’1 have all been recognized clinically and several are more important than the “pulseless disease” of young women. Incomplete examples of the syndrome are more common than complete ones and this probably explains to a considerable extent the lack of attention that has been given to this group of conditions. Since they are potentially disabling and may lead to death, they deserve careful scrutiny. In addition, it is now possible in most instances to make a proper etiological and anatomic diagnosis and in some cases to perform corrective surgery. In other cases medical treatment appears to be of benefit. The case studies to be presented are in no way typical but rather exemplify the wide variety of clinical manifestations that may be encountered.