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Ann Thorac Surg 1997;64:292-293
© 1997 The Society of Thoracic Surgeons

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Correspondence

Innominate and Subclavian Arteries as an Inflow of Free Arterial Graft

Department of Cardiovascular Surgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba 305,Japan.

To the Editor:

I read with interest the operative technique presented by Dr Suma [1], under whom I had surgical training. The free arterial grafts were proximally anastomosed to the innominate and subclavian arteries with excellent results. I had a great impression that the angiographic finding was perfect.

However, there is a point to be discussed in the operative strategy. To place a side-biting clamp on the arch vessels is also a risky procedure for stroke in patients with a diseased ascending aorta. A calcified or atherosclerotic ascending aorta often extends to the aortic arch. In my experience of total arch graft replacements for atherosclerotic aortic aneurysms, I sometimes found that the wall of the innominate artery was atheromatous, which I do not believe could be detected only by palpation.

In patients who require "aortic no-touch technique" [2] because of diseased ascending aorta, the arch vessels also should be untouched. I believe that the proximal anastomosis could be performed under hypothermic circulatory arrest.

References

1. Suma H. Innominate and subclavian arteries as an inflow of free arterial graft. Ann Thorac Surg 1966;62:1865–6.[Abstract/Free Full Text]
2. Suma H. Coronary artery bypass grafting in patients with calcified ascending aorta: aortic no-touch technique. Ann Thorac Surg 1989;48:728–30.[Abstract/Free Full Text]

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