Atherosclerotic innominate artery occlusive disease: early and long-term results of surgical reconstruction.
OBJECTIVE
Few articles have dealt specifically with surgical management of innominate artery (IA) atherosclerotic occlusive disease. We herein present our early and long-term results in a large series of patients.


METHODS
During a 20-year period (1974 to 1993) we operated on 148 patients with IA atherosclerotic occlusive disease. The mean age was 55.8 +/- 9.4 years. Approach was through a median sternotomy in 135 (91%) patients. Endarterectomy was performed in 32 (22%) patients, whereas 116 (78%) patients underwent bypass.


RESULTS
Eight (5.4%) patients died in the perioperative period (four of heart-related causes, two of hemorrhage, one each of pulmonary infection and multiorgan failure). There were five (3.4%) perioperative strokes (three ipsilateral, two contralateral) and three (2.0%) ipsilateral perioperative transient ischemic attacks. Ten (7%) patients were lost to follow-up. Mean follow-up was 77 (2 to 193) months. Thirty-three (24%) patients were monitored 10 or more years. There were 45 (35%) late deaths (19 from cardiovascular-related causes, 15 from cancer, 7 from other known causes, and 4 from unknown causes). Although 11 (8.5%) patients had late neurologic events, only one late stroke occurred in the contralateral hemisphere and no ipsilateral late strokes occurred. Sixteen (11%) patients had late myocardial infarctions, nine of which were lethal. Life-table analysis and perioperative events were used to calculate the probability of survival, which was 77.5% +/- 9.5% and 51.9% +/- 20.8% at 5 and 10 years, respectively, with a 4.4% annual mortality rate. The overall probability of freedom from any neurologic/ocular event was 88.8% +/- 6.2% and 80.4% +/- 11.9% at 5 and 10 years, respectively, with a 1.6% annual occurrence rate. The probability of freedom from ipsilateral neurologic/ocular event was 92.7% +/- 4.8% and 84.0% +/- 11.2% at 5 and 10 years, respectively, with a 1.4% annual occurrence rate. The probability of freedom from ipsilateral stroke was 98.6% +/- 1.9% at 5 and 10 years. The primary patency rate was 98.4% +/- 2.1% and 96.3% +/- 4.7% at 5 and 10 years, respectively. The probability of freedom from reoperation was 95.6% +/- 3.9% and 93.5% +/- 5.9% at 5 and 10 years, respectively.


CONCLUSIONS
Surgical reconstruction of IA atherosclerotic occlusive disease yields acceptable rates of perioperative complications and late mortality and excellent long-term patency and freedom from neurologic events and reoperation.
Department of Vascular Surgery, Pitié-Salpétrière University Hospital, Paris, France.
E
E
Kieffer
J
J
Sabatier
F
F
Koskas
A
A
Bahnini
D000328:Adult; D000368:Aged; D001161:Arteriosclerosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016122:Brachiocephalic Trunk / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000209:etiology; D004691:Endarterectomy / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D011183:Postoperative Complications; D011336:Probability; D012086:Reoperation; D013249:Sternum / Q000601:surgery; D015996:Survival Rate; D013908:Thoracotomy; D016896:Treatment Outcome; D014654:Vascular Patency