Surgical Reconstruction for Innominate Artery Occlusive Disease

Abstract

The incidence of occlusive disease affecting the innominate artery is unknown because severe atherosclerotic lesions remain undetected by commonly employed screening modalities such as duplex ultrasound. Furthermore, symptoms are frequently minimal and clinical examination findings are subtle. However, abnormalities of the aortic arch branch vessels are increasingly encountered in patients with severe peripheral vascular disorders (Ballard 2001; Chang et al. 1997; Owens et al. 1995; Sakopoulos et al. 2000; Twena and Ballard 2000). In addition, the atherosclerotic process tends to occur in the proximal one-third of these arteries. This makes upper mediastinal access ideal for surgical reconstruction of innominate artery occlusive disease (Owens et al. 1995; Twena and Ballard 2000). The mini-sternotomy technique described in this chapter maximizes direct surgical reconstruction options such as aorto-in-nominate artery bypass and, less commonly, innominate artery endarterectomy. Alternatively, extrathoracic bypass procedures utilizing the subclavian and/ or axillary arteries may be advisable for prohibitive surgical risk patients or if the planned sternotomy would be a complex re-do procedure.