Safety of left innominate vein division during aortic arch surgery

Chittoor Sai Sudhakar, John A. Elefteriades

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background. The surgical approach to the aortic arch via median sternotomy can be hindered by the left innominate vein (LIV). Retraction of the LIV may injure the vein. The safety of LIV ligation has been controversial. Opinion has also differed regarding whether a divided vein should be reanastomosed after arch replacement is completed. We report our experience with division and ligation of the LIV for improved aortic arch exposure and facilitated excision of mediastinal tumors. Methods. From January 1996 to June 1998, the LIV was divided and ligated in 14 patients (8 men, 4 women) after consideration of local anatomy, adequacy of aortic arch exposure, level of distal aortic anastomosis, and in case of mediastinal tumors, extent of involvement of mediastinal structures. The LIV was divided between clamps, doubly ligated, and the ends oversewn. Patients were assessed at 1 month and at yearly intervals for upper extremity edema and neurologic symptoms. Results. In 12 patients LIV division improved aortic arch access, and in 2 patients, it facilitated excision of mediastinal tumors. The mean age of patients was 56 years (range 22 to 80). Follow-up ranged from 1 week to 30 months. All patients had left upper extremity edema for 7 to 10 days, which resolved with arm elevation. One early patient required reexploration for bleeding from the LIV stump. One patient died because of multiorgan dysfunction. None had any residual left upper extremity edema or neurologic symptoms. Conclusions. We conclude that, although not uniformly or commonly necessary, division of the LIV can safely be utilized to facilitate aortic arch exposure without significant long-term morbidity. LIV reanastomosis is not necessary. (C) 2000 by The Society of Thoracic Surgeons.

Original languageEnglish (US)
Pages (from-to)856-858
Number of pages3
JournalAnnals of Thoracic Surgery
Volume70
Issue number3
DOIs
StatePublished - Oct 17 2000
Externally publishedYes

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Brachiocephalic Veins
Thoracic Aorta
Safety
Upper Extremity
Edema
Neurologic Manifestations
Ligation
Veins
Neoplasms
Sternotomy
Anatomy
Arm

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Safety of left innominate vein division during aortic arch surgery. / Sai Sudhakar, Chittoor; Elefteriades, John A.

In: Annals of Thoracic Surgery, Vol. 70, No. 3, 17.10.2000, p. 856-858.

Research output: Contribution to journalArticle

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