Technical principles of direct innominate artery revascularization: a comparison of endarterectomy and bypass grafts.

Occlusive lesions of the innominate artery that require operation occur infrequently. Direct repair has been performed with low morbidity and mortality. There is debate over the best method of direct reconstruction. Twenty-six patients undergoing transsternal innominate artery repair over a 12-year period were reviewed to determine if either grafting or endarterectomy was superior and what technical factors might be responsible for success or failure. Most of the patients were women. Twenty-four of the patients had atherosclerotic lesions, whereas the other two had Takayasu's arteritis. Either neurologic or right upper extremity symptoms were present in 24 patients. Sixteen patients had grafting, and 10 underwent endarterectomy. There was one death. There were no strokes or transient ischemic attacks. Three patients experienced recurrence of their symptoms; all had failures of reconstruction. The use of a bifurcated graft in one patient was probably responsible for one recurrence of symptoms. Single limb grafts with added side arms are probably preferable to bifurcated grafts. Innominate artery grafting and innominate endarterectomy are equally effective, although grafting is applicable to more patients. Direct transsternal repair is the procedure of choice to correct innominate occlusive disease in patients who are good candidates for correction.