Evolving Strategies in Treatment of Isolated Symptomatic Innominate Artery Disease

• Published in: Vascular and endovascular surgery 2008-10, Vol.42 (5), p.440-445
• Main Authors: Palchik, Eugene, Bakken, Andrew M., Wolford, Heather Y., Waldman, David L., Davies, Mark G.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Arterial Occlusive Diseases - physiopathology; Arterial Occlusive Diseases - surgery; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Brachiocephalic Trunk - physiopathology; Brachiocephalic Trunk - surgery; Cardiology. Vascular system; Constriction, Pathologic; Female; Humans; Male; Medical sciences; Middle Aged; Retrospective Studies; Stents; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Treatment Outcome; Vascular Patency; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 1538-5744; 1938-9116
• DOI: 10.1177/1538574408315994

Purpose: To examine the evolving roles of endovascular and open approaches in treatment of symptomatic innominate artery (IA) disease. Methods: Patients treated for symptomatic IA lesions with or without involvement of the right common carotid and/or right subclavian arteries between 1997 and 2006 were identified. Charts and diagnostic studies were retrospectively reviewed. Results: Of 18 patients treated, 8 required open reconstruction. Ten patients with high-grade focal stenosis were stented. Immediate technical and clinical success was 100% among all patients. Mean follow-up time was 25 and 27 months for endovascular and open interventions, respectively. The primary patency rates were 78% ± 14 and 80% ± 10 for endovascular and open groups, respectively. Assisted primary patency rate was 100% for both groups. There were no peri-operative mortalities or neurological events. We encountered two systemic (pulmonary) complications and one access-related complication among open and endovascular patients, respectively. Conclusion: Endovascular repair is evolving as a primary mode of therapy for focal IA lesions while open approach is reserved for more extensive disease. Patho-anatomical characteristics of a given IAlesion along with peri-operative risk assessment determine a proper surgical approach.