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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Italian Journal of Vascular and Endovascular Surgery 2012 December;19(4):253-8
Transmediastinal repair of the innominate artery: immediate and long-term outcomes of 42 surgical reconstructions
Duran M. 1, Grotemeyer D. 1, Schander O. 1, Blondin E. 2, Sandmann W. 1
1 Department of Vascular Surgery and Kidney Transplantation, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany;
2 Institute of Diagnostic and Interventional Radiology, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
AIM: This is a review of the surgical outcomes of 42 patients who underwent innominate artery revascularization during a 14.5-year period.
METHODS: Between 01/01/1997 and 06/30/2011, 42 consecutive patients (mean age 56.6 years, female 61.9%, male 38.1%) with involvement of the innominate artery alone or of several aortic arch branches underwent operative reconstruction, which was performed using a transthoracic approach in all cases. In a retrospective study, patients records on clinical symptoms, diagnostic measures and surgical procedures were evaluated.
RESULTS: In 31 cases, the innominate artery displayed significant stenosis; in 11 cases, the artery was occluded. In 34 patients, other supra-aortic arteries were involved as well. Therefore, simultaneous endarterectomy was performed at the vertebral artery (N.=1, 2.6%), internal carotid artery (N.=4, 10.7%) and common carotid artery (N.=6, 15.4%). The primary patency was 97.6%. One early occlusion was encountered. This patient underwent a second revascularization procedure without neurological complications; the secondary patency rate amounted to 100%. In seven (17.9%) cases, complications occurred after surgery. The 30-day mortality rate was 0%. Follow-up was successfully achieved for 1-130 months (mean 47.8 months) in 35 (83.3%) cases. Seven (16.6%) patients were dead at the time of follow-up. Twenty-eight patients (66.6%) remained asymptomatic, and symptoms of arm ischemia remained or occurred in seven cases.
CONCLUSION: We see no argument to favour an endovascular intervention in lesions of the innominate artery because a transthoracic innominate artery reconstruction with an interposition graft can be performed with acceptably low morbidity and mortality. In our study, the procedure resulted in excellent long-term patency and confirm the findings of a previous study on 32 patients from our institution published 16 years ago. Further prospective studies are needed to compare endovascular treatment and open surgery. Currently, open surgery is the standard treatment for all lesions of the innominate artery, while endovascular therapy has become the standard procedure for selected groups.