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Evolving Strategies in Treatment of Isolated Symptomatic Innominate Artery Disease

Department of Surgery and Department of Imaging Sciences, Center for Vascular Disease, University of Rochester, Rochester, New York

Andrew M. Bakken, MD

Department of Surgery and Department of Imaging Sciences, Center for Vascular Disease, University of Rochester, Rochester, New York

Heather Y. Wolford, MD

Department of Surgery and Department of Imaging Sciences, Center for Vascular Disease, University of Rochester, Rochester, New York

David L. Waldman, MD, PhD

Department of Surgery and Department of Imaging Sciences, Center for Vascular Disease, University of Rochester, Rochester, New York

Mark G. Davies, MD, PhD

Department of Surgery and Department of Imaging Sciences, Center for Vascular Disease, University of Rochester, Rochester, New York, mark_davies{at}urmc.rochester.edu

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.

Key Words: innominate • brachiocephalic • stenosis • endovascular • stent

This version was published on October 1, 2008

Vascular and Endovascular Surgery, Vol. 42, No. 5, 440-445 (2008)
DOI: 10.1177/1538574408315994


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