Related Experiment Videos
Innominate artery occlusive disease: management with central reconstructive techniques
J Ligush1, E Criado, B A Keagy
1Division of Surgical Sciences, Bowman Gray School of Medicine, Winston-Salem, NC 27157, USA.
Surgery
|May 1, 1997
Summary
Central vascular reconstruction for innominate artery (IA) occlusive disease effectively relieves symptoms with high graft patency. Procedures like aortocarotid bypass and angioplasty are viable options, but should be reserved for symptomatic patients due to associated morbidity.
Area of Science:
- Vascular Surgery
- Cardiovascular Disease
- Interventional Cardiology
Background:
- Innominate artery (IA) occlusive disease affects patients with symptoms like amaurosis fugax, TIAs, and arm claudication.
- Eighteen patients with IA occlusive disease underwent central vascular reconstruction between 1986 and 1994.
- Prevalence of IA occlusion was lower than stenosis, with some patients having prior failed bypass procedures.
Purpose of the Study:
- To review the experience with central vascular reconstruction for innominate artery occlusive disease.
- To evaluate the effectiveness and outcomes of surgical interventions for IA occlusive disease.
- To assess the role of different surgical techniques and endovascular approaches.
Main Methods:
- Surgical interventions included aortocarotid bypass with subclavian reimplantation (n=10) and aortoinnominate bypass (n=7) via median sternotomy.
- Transection and oversewing of the IA was the primary technique, with ligation in one case.
- One patient with comorbidities underwent retrograde transluminal IA angioplasty with stent placement; concomitant procedures included carotid endarterectomy and coronary artery bypass grafting.
Main Results:
- One operative death occurred due to myocardial infarction; perioperative morbidity included arrhythmias, respiratory insufficiency, and myocardial infarction.
- All grafts remained patent at a mean follow-up of 21 months.
- The patient undergoing IA ligation required revision, while the angioplasty patient remained asymptomatic; hospital stays differed significantly between open repair and angioplasty.
Conclusions:
- Innominate artery bypass from the ascending aorta is effective for symptom relief and demonstrates high patency rates.
- Due to significant morbidity, these reconstructive procedures should be reserved for symptomatic individuals.
- Transection and oversewing of the IA is recommended to prevent embolism; angioplasty is an alternative for stenotic lesions, and evaluation for coronary artery disease is crucial.