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Avoiding a sternotomy for symptomatic supra-aortic trunk disease utilizing an extra-anatomic carotid-to-carotid
Nicola M Habash1, Calvin L Chao1, Nidhi K Reddy1
1Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
Insights
Carotid-to-carotid bypass effectively treats innominate artery occlusive disease (IAOD), providing lasting symptom relief and graft patency. This approach offers a viable revascularization option for complex IAOD cases.
Area of Science:
- Vascular Surgery
- Cerebrovascular Disease
- Arterial Occlusive Disease
Background:
- Innominate artery occlusive disease (IAOD) is a rare but serious condition causing ischemia in the brain and arms.
- Revascularization is often necessary for symptomatic IAOD.
- Carotid-to-carotid bypass is an alternative surgical strategy.
Observation:
- This case series evaluated patients with symptomatic IAOD managed with carotid-to-carotid bypass.
- The study included patients with prior failed endovascular treatments, extensive arterial calcification, and high surgical risks.
- Three distinct clinical scenarios were highlighted.
Findings:
- Carotid-to-carotid bypass demonstrated sustained symptom relief and excellent graft patency in the studied cohort.
- The procedure proved effective even in patients with significant comorbidities.
- Key management considerations include patient selection, technical aspects, and long-term outcomes.
Implications:
- Carotid-to-carotid bypass is a feasible and effective extra-thoracic revascularization option for select IAOD patients.
- A personalized, patient-centered strategy is crucial for successful IAOD management.
- Further research into long-term outcomes of this bypass technique is warranted.
Abstract:
Innominate artery occlusive disease (IAOD) is an uncommon yet significant cause of cerebral and upper extremity ischemia, often requiring revascularization. We present a case series of patients with symptomatic IAOD managed with carotid-to-carotid bypass, highlighting three distinct clinical scenarios, including failed prior endovascular intervention, extensive supra-aortic trunk calcification, and high surgical risk prohibiting sternotomy. Our findings emphasize key considerations in IAOD management, including patient selection, technical feasibility, and long-term outcomes of extra thoracic revascularization. Despite complex comorbidities, carotid-to-carotid bypass provided sustained symptom relief and graft patency in our cohort. A patient-centered approach remains essential for optimizing outcomes in this population.
