Safety of left innominate vein division during aortic arch surgery

Background. The surgical approach to the aortic arch via median sternotomy can be hindered by the left innominate vein (LIV). Retraction of the LIV ma y injure the vein. The safety of LIV ligation has been controversial. Opini on has also differed regarding whether a divided vein should be reanastomos ed after arch replacement is completed. We report our experience with divis ion and ligation of the LIV for improved aortic arch exposure and facilitat ed excision of mediastinal tumors. Methods. From January 1996 to June 1998, the LIV was divided and ligated in 14 patients (8 men, 4 women) after consideration of local anatomy, adequac y of aortic arch exposure, level of distal aortic anastomosis, and in case of mediastinal tumors, extent of involvement of mediastinal structures. The LIV was divided between clamps, doubly ligated, and the ends oversewn. Pat ients were assessed at 1 month and at yearly intervals for upper extremity edema and neurologic symptoms. Results. In 12 patients LIV division improved aortic arch access, and in 2 patients, it facilitated excision of mediastinal tumors. The mean age of pa tients was 56 years (range 22 to 80). Follow-up ranged from 1 week to 30 mo nths. All patients had left upper extremity edema for 7 to 10 days, which r esolved with ann elevation. One early patient required reexploration for bl eeding from the LIV stump. One patient died because of multiorgan dysfuncti on. None had any residual left upper extremity edema or neurologic symptoms . Conclusions. We conclude that, although not uniformly or commonly necessary , division of the LIV can safely be utilized to facilitate aortic arch expo sure without significant long-term morbidity. LIV reanastomosis is not nece ssary. (Ann Thorac Surg 2000;70:856-8) (C) 2000 by The Society of Thoracic Surgeons.