Aneurysms of the innominate artery: Surgical treatment of 27 patients

Purpose: Aneurysms of the innominate artery (AIA) are widely considered to be a rare entity. We describe our experience with AIAs in the last three de cades. Methods. From October 1973 to October 2000, we operated on 27 patients with an AIA. The underlying cause of aneurysm was Takayasu's disease in 7 patie nts, degenerative disease in 6 patients, syphilis in 5 patients, chronic di ssection in 3 patients, trauma in 2 patients, infection in 2 patients, a po stoperative complication in I patient, and Marfan syndrome in 1 patient. AI A was associated with an aortic aneurysm in 17 patients. Fourteen patients had no symptoms. The remaining patients had symptoms, with thromboembolic c omplications in 7 patients, pain without rupture in 3 patients, and a ruptu red aneurysm in 3 patients. In two patients at high risk for surgery who ha d a small ATA with embolic complications, a cervical approach was used as a means of performing distal exclusion and crossover bypass. In the remainin g 25 patients, a midline sternotomy was used. One patient with a ruptured A IA exsanguinated during sternotomy. Ten patients underwent a prosthetic rep lacement of the ascending aorta and/or aortic arch with a separate prosthet ic branch to the innominate artery (IA). Thirteen patients underwent ascend ing aorta-to-IA prosthetic bypass in association with lateral suture (8 pat ients) or prosthetic patching (5 patients) of the aorta. One patient with a n infected aneurysm was treated by means of resection of the aneurysm, prox imal ligation of the IA, and transposition of the right into the left commo n carotid artery. Cardiopulmonary bypass with deep hypothermic circulatory arrest was used in 10 patients. Results. Three perioperative deaths occurred (2 of 4 in association with em ergency treatment and 1 of 23 with elective treatment). Respiratory complic ations requiring prolonged artificial ventilation developed in five patient s. Two patients had transient worsening of preoperative neurologic deficits . Late results, with a mean follow-up of 85 months, were good. Conclusion: The etiology and presentation of AIAs are variable. Surgical ma nagement with current cardiovascular techniques achieves excellent results.