Abstract
We report three cases of symptomatic stenosis of the great vessels or supra-aortic trunks successfully treated surgically with aorto-subclavian and aorto-innominate bypass. Two were performed via manubriotomy and a third case via standard median sternotomy because of concomitant coronary revascularisation. There was complete symptomatic relief on follow-up, and radiological imaging confirmed good flow in the grafts and post-stenotic arteries.
Highlights
Like other arteries, the innominate, left common carotid and subclavian arteries or supra-aortic trunks (SATs) can be affected by atherosclerosis
Many patients with SAT disease are asymptomatic, but some may present with symptoms of cerebral or limb ischaemia
The morbidity associated with the transthoracic route may be reduced by using a less invasive approach such as manubriotomy
Summary
The innominate, left common carotid and subclavian arteries or supra-aortic trunks (SATs) can be affected by atherosclerosis. The skin was incised above the clavicle from the left mid-clavicular point to the suprasternal notch and the incision extended vertically downwards towards the manubriosternal junction This was followed by a vertical manubriotomy extending laterally to the left, stopping short of the internal mammary pedicle. The innominate artery was clamped with a single partial occlusion clamp distal to the lesion and a 5 mm Goretex graft sutured to it under full heparinization (Fig 2). This was followed by standard triple coronary artery bypass grafting. Postoperative magnetic resonance imaging showed a patent aorto-innominate bypass with good antegrade flow in the right carotid and subclavian arteries (Fig 3). The patient had an uneventful recovery with complete resolution of all symptoms (angina, diplopia and exertional arm pain) on follow-up
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