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Atherosclerotic disease of the innominate artery: current management and results
D Mellière1, J P Becquemin, N E Benyahia
1Division of Vascular Surgery, University Paris XII, France.
Insights
Surgical repair of innominate artery atherosclerotic disease depends on lesion type and patient health. Bypass grafting via sternotomy is often preferred, but angioplasty or cervical bypass may be suitable in select cases.
Area of Science:
- Vascular Surgery
- Cardiovascular Disease
Background:
- Innominate artery atherosclerotic disease often requires surgical intervention.
- Sternotomy with bypass grafting has been the traditional approach.
Purpose of the Study:
- To evaluate different surgical strategies for innominate artery atherosclerotic disease.
- To determine the optimal procedure based on lesion characteristics and patient condition.
Main Methods:
- Retrospective analysis of 22 patients with innominate artery disease.
- Procedures included bypass grafting (n=17), endarterectomy (n=2), and cervical approaches (n=3).
- Evaluation of early and late postoperative outcomes.
Main Results:
- All 22 patients had satisfactory early and late results with uneventful postoperative courses.
- Bypass grafting via sternotomy was frequently employed.
- Endarterectomy and cervical procedures were used in specific patient subsets.
Conclusions:
- The choice of procedure for innominate artery atherosclerotic disease is individualized.
- Bypass grafting via sternotomy is generally favored due to risks associated with endarterectomy.
- Percutaneous angioplasty or carotid-to-carotid bypass are viable alternatives in selected patients.
Abstract:
Arterial repair through a sternotomy has long been considered the procedure of choice for innominate artery atherosclerotic disease. Of 22 patients presenting with 21 occlusive lesions and one aneurysm, 17 patients underwent a bypass procedure, and two, an endarterectomy through a sternotomy, whereas three patients underwent cervical procedures. Their postoperative course was uneventful. Early and late results were satisfactory. We conclude that in patients with innominate artery atherosclerotic disease, the procedure employed depends on both the type of lesion and the clinical status of the patient. In most cases, a bypass graft via a sternotomy is the best option, since endarterectomy is not always possible and risks an aortic tear or dissection. In selected cases, balloon angioplasty performed either percutaneously, combined with cerebral protection by an occlusive balloon in the carotid artery or through a carotid arteriotomy in order to flush out embolic material may be sufficient. A by-pass graft from the right to the left common carotid artery is the best procedure in patients with neurological symptoms when angioplasty seems inappropriate, and when sternotomy is contraindicated for either reasons of poor health or a prior mediastinal operation.