Atherosclerotic innominate artery occlusive disease: Early and long-term results of surgical reconstruction

Abstract

Few articles have dealt specifically with surgical management of innominate artery (IA) atherosclerotic occlusive disease. We herein present our early and long-term results in a large series of patients. During a 20-year period (1974 to 1993) we operated on 148 patients with IA atherosclerotic occlusive disease. The mean age was 55.8 +/- 9.4 years. Approach was through a median sternotomy in 135 (91%) patients. Endarterectomy was performed in 32 (22%) patients, whereas 116 (78%) patients underwent bypass. Eight (5.4%) patients died in the perioperative period (four of heart-related causes, two of hemorrhage, one each of pulmonary infection and multiorgan failure). There were five (3.4%) perioperative strokes (three ipsilateral, two contralateral) and three (2.0%) ipsilateral perioperative transient ischemic attacks. Ten (7%) patients were lost to follow-up. Mean follow-up was 77 (2 to 193) months. Thirty-three (24%) patients were monitored 10 or more years. There were 45 (35%) late deaths (19 from cardiovascular-related causes, 15 from cancer, 7 from other known causes, and 4 from unknown causes). Although 11 (8.5%) patients had late neurologic events, only one late stroke occurred in the contralateral hemisphere and no ipsilateral late strokes occurred. Sixteen (11%) patients had late myocardial infarctions, nine of which were lethal. Life-table analysis and perioperative events were used to calculate the probability of survival, which was 77.5% +/- 9.5% and 51.9% +/- 20.8% at 5 and 10 years, respectively, with a 4.4% annual mortality rate. The overall probability of freedom from any neurologic/ocular event was 88.8% +/- 6.2% and 80.4% +/- 11.9% at 5 and 10 years, respectively, with a 1.6% annual occurrence rate. The probability of freedom from ipsilateral neurologic/ocular event was 92.7% +/- 4.8% and 84.0% +/- 11.2% at 5 and 10 years, respectively, with a 1.4% annual occurrence rate. The probability of freedom from ipsilateral stroke was 98.6% +/- 1.9% at 5 and 10 years. The primary patency rate was 98.4% +/- 2.1% and 96.3% +/- 4.7% at 5 and 10 years, respectively. The probability of freedom from reoperation was 95.6% +/- 3.9% and 93.5% +/- 5.9% at 5 and 10 years, respectively. Surgical reconstruction of IA atherosclerotic occlusive disease yields acceptable rates of perioperative complications and late mortality and excellent long-term patency and freedom from neurologic events and reoperation.