Print this pageInnominate Artery Revascularization: Open or Endoluminal Therapy?
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Heather Y. Wolford, MD, Richard Lee, MD, Michael J. Singh, MD, Jeffrey M. Rhodes, MD, Karl A. Illig, MD, David L. Waldman, MD, PhD, Mark G. Davies, MD, PhD.
University of Rochester, Rochester, NY, USA.
OBJECTIVE: To compare the outcomes between open surgery and endoluminal therapy for innominate artery disease.
METHODS: A retrospective chart review was conducted of consecutive patients undergoing intervention for isolated innominate artery disease. Over a 10 year period (7/1994-1/2005), 21 patients underwent therapy for innominate artery disease. Mean follow-up was 37months (range: 0-131mns). Patency rates were determined by life table analysis.
RESULTS: Of the 21 patients, 13 had open surgical repair (12 aorto-distal bypasses, 1 endarterectomy) and 8 underwent endoluminal intervention. Demographics were similar between the groups, with a preponderance of heavy tobacco use (41±5 pack years). Indications for intervention included arm ischemia (14%), cerebrovascular symptoms (76%), and pseudoaneurysm (10%). There was one peri-operative mortality in each group, both secondary to rupture of their innominate artery pseudoaneurysms. Peri-operative events and patency rates are detailed in the table below. There were no peri-operative neurological events in either group. During the follow-up period, one patient in the open surgical group required stent placement for continued symptoms and one patient had a partial occlusion of his graft. In the endoluminal group, one patient required open surgical bypass for recurrent symptoms.
CONCLUSIONS: Both open surgical and endoluminal therapy provide satisfactory mid-term patency rates for revascularization of innominate artery occlusive disease. Pseudoaneurysm of the innominate artery is a highly lethal condition regardless of treatment modality. There is a non-significant trend towards fewer complications in the endoluminal therapy group. Given the equivalency between the 2 modes of therapy, endoluminal intervention is a reasonable primary therapy.
| Therapy | N | 30 day Mortality | 30-day Morbidity | 2 year PP | 2 year SP |
| Open Surgery | 13 | 1 (8%) | 5 (38%) | 76±16 | 85±13 |
| Endoluminal | 8 | 1 (12%) | 2 (25%) | 65±27 | 87±18 |
| Total | 21 | 2 (10%) | 7 (33%) | 72±14 | 85±11 |
PP= primary patency; SP=secondary patency; Patency rates= %±Standard error
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