Innominate artery occlusive disease: surgical approach and long-term results.
We reviewed our experience with 54 patients who underwent innominate artery revascularization during a 10-year period. Their age range was from 16 to 75 years (mean, 49.8 years). The innominate artery alone was involved in 21 patients (39%); the remaining patients had additional arch vessel obstructions. Before operation, neurologic symptoms occurred in 25 patients (46%), arm ischemia related to claudication and microembolization occurred in 8 patients (14%), a combination of symptoms occurred in 17 patients (32%), and no symptoms were noted in 4 patients (8%). The extrathoracic approach to surgery was used in 16 patients (30%). Eleven of the 38 patients in whom the intrathoracic approach was used had endarterectomy of the innominate artery; in three of those, the procedure was combined with left common carotid endarterectomy. Bypass grafts were used in the other 27 patients undergoing procedures with an intrathoracic approach; in six of those, bypass was combined with carotid endarterectomy. No operative deaths occurred. Perioperative revascularization failure occurred in four cases; all of those patients underwent a second revascularization procedure, with a secondary patency rate of 100%. In four patients, late occlusion was noted at 6 months and at 1, 1.5, and 10 years. One patient had a permanent perioperative neurologic deficit in the distribution of the left carotid artery after a combined common carotid endarterectomy/innominate endarterectomy procedure. No neurologic deficits were directly related to the innominate artery territory. Long-term actuarial survival was 83% at 10 years. Early and late graft failures were related to inadequate inflow in bypass grafts, progression of distal disease in arteritis, and primary closure in endarterectomy.
Reul
G J
GJ
Department of Cardiovascular Surgery, Texas Heart Institute, Houston 77225-0345.
Jacobs
M J
MJ
Gregoric
I D
ID
Calderon
M
M
Duncan
J M
JM
Ott
D A
DA
Livesay
J J
JJ
Cooley
D A
DA
D000293:Adolescent; D000328:Adult; D000368:Aged; D001011:Aorta / Q000601:surgery; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D016122:Brachiocephalic Trunk / Q000601:surgery*; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D004691:Endarterectomy; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications; D011379:Prognosis; D015996:Survival Rate
D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene