INNOMINATE-ARTERY RECONSTRUCTION - OVER 3 DECADES OF EXPERIENCE

Summ. Background Data Symptomatic atherosclerotic occlusive disease of the innominate artery is a threatening disease pattern that offers a major challenge in achieving definitive surgical repair. To assess the evolution of treatment strategies and their outcomes for this disease , the authors undertook a review of the cumulative experience for more than 3 decades at one institution. Methods Between 1960 and 1997, 94 patients (mean age, 62 years) underwent direct innominate artery revas cularization for occlusive atherosclerotic disease to relieve neurolog ic (n = 85) and/or right upper extremity (n = 26) symptoms or asymptom atic critical stenosis (n = 3), The pattern of atherosclerotic involve ment revealed by angiography included critical stenosis (n = 77), comp lete occlusion (n = 10), and moderate stenosis with plaque ulceration (n = 7). A common brachiocephallic trunk was present in five patients. Transsternal (n = 68) or transcervical (n = 4) innominate endarterect omy was performed in 72 patients and bypass grafting in 22, Forty-one patients underwent concomitant endarterectomy or bypass of innominate branches or adjacent arch vessels, and 3 had coronary bypass grafting. Results There were three perioperative deaths (3%), all due to cardia c causes. Postoperative morbidity included four strokes (three resolve d), two myocardial infarctions, two transient ischemic attacks, and on e sternal dehiscence. Follow-up ranged from 8 months to 20 years. Post operative actuarial survival rate was 96% at 1 year, 85% at 5 years, a nd 67% at 10 years. Freedom from recurrence requiring reoperation was 100% at 1 year, 99% at 5 years, and 97% at 10 years. Conclusions Innom inate artery reconstruction is safe and durable when either endarterec tomy or prosthetic bypass is used. The anatomic variation and disease distribution permit endarterectomy for most patients. The technique of innominate endarterectomy can be extended safely to outflow and adjac ent vessels.