Transthoracic reconstructions of the innominate artery with atherosclerotic occlusions

Literature reports concerning transthoracic reconstructive operations of the innominate artery (IA) are rare.

Six men and one woman aged from 48 to 64 years were operated on -- all of them had atherosclerotic IA lesions. Some of them had additional vascular disease such as coronary atherosclerotic lesions in one patient, another one had chronic arterial ischemia (CM) of the lower extremities and one patient underwent a stroke. All the patients had some neurological symptoms (headache, dizziness) and chronic arterial insufficiency of the right arm, five patients had clinically and arteriographically detected subclavian steal syndrome (SSS) with vertebrobasilar symptoms (ataxia and syncops). Peripheral arterial pressure (PAP) of both arms gave a difference from 30 to 80 mmHg. Aortoarteriography showed one stenosis and 6 thromboses of the IA, the left common carotid artery (LCCA) was affected in two cases. All operations were done through a longitudinal sternotomy continued by cervicotomy. In one patient an endarterectomy (EA) of IA was done. In six patients a bypass operation was performed. The ascending aorta was used for inflow. The distal anastomoses were with the distal part of the IA, in two patients, with the right subclavian artery (RSA) and the right common carotid artery (RCCA) in two patients and with RSA, RCCA and LCCA in two cases.

There was no operative or postoperative mortality, the postoperative complications were pericarditis and pneumonia. The patients were observed for a period of 18 months to 10 years. The use of Doppler-control provided patency data of arterial grafts in all the patients. One patient died of a heart attack five years after surgery, another had an ischemic stroke of the left hemisphere four years after surgery.

The authors consider that transthoracic IA reconstructions, although being traumatic, give good early and long-term results.