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Yanagihara W, Akamatsu Y, Shibanai K, Fujimoto K, Kojima D, Kashimura H, Kubo Y, Ogasawara K. Cerebral protection during retrograde brachiocephalic artery stenting using a single filter and increased subclavian steal phenomenon: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 4:CASE22194. [PMID: 35855349 PMCID: PMC9257397 DOI: 10.3171/case22194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/25/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Cerebral protection during brachiocephalic artery (BCA) stenting is important. However, the maneuver is sometimes challenging because both the internal carotid artery (ICA) and vertebral artery (VA) should be protected. Herein, the authors present an alternative cerebral protection technique involving filter protection for the ICA and hemodynamic protection for the VA during retrograde BCA stenting. OBSERVATIONS A 64-year-old man with a thoracic aortic aneurysm presented with cold sensation and numbness in his right arm due to BCA stenosis. Endovascular stenting under cerebral protection was planned. Cerebral protection was attempted through the brachial access. Despite the successful placement of the filter in the ICA, selective catheterization of the VA failed. Furthermore, repeated transfemoral catheterization of the BCA was unsuccessful. Concerning a thoracic aortic aneurysm injury, the authors performed retrograde BCA stenting using a transbrachial approach. Hemodynamic protection of the VA was provided by increasing the subclavian steal phenomenon that resulted in successful recanalization of the BCA. LESSONS Retrograde BCA stenting performed while protecting the ICA with a filter and the right VA by increasing the subclavian steal phenomenon was successful. This simple technique is feasible, especially in patients with steno-occlusive lesions of the BCA concurrent with the dominant vertebra/vertebral collateral pathway.
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Affiliation(s)
- Wataru Yanagihara
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba-cho, Iwate, Japan
- Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan; and
| | - Yosuke Akamatsu
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba-cho, Iwate, Japan
- Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan; and
| | - Kazuo Shibanai
- Department of Neurosurgery, Kitakami Saiseikai Hospital, Kitakami, Iwate, Japan
| | - Kentaro Fujimoto
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba-cho, Iwate, Japan
| | - Daigo Kojima
- Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan; and
| | - Hiroshi Kashimura
- Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan; and
| | - Yoshitaka Kubo
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba-cho, Iwate, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba-cho, Iwate, Japan
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2
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Torrealba JI, Valdés FJ, Garrido L, Mertens R, Mariné L, Bergoeing M, Vargas F. Acute Symptomatic Free-Floating Thrombus in the Innominate Artery, a Case Series. Vasc Endovascular Surg 2022; 56:15385744221098812. [PMID: 35506432 DOI: 10.1177/15385744221098812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Innominate artery embolism may result in upper extremity ischemia or stroke. A free-floating thrombus originating from the IA is an unusual and dangerous disorder with embolic potential. Only isolated cases have been described showing different treatment modalities. PURPOSE To present 3 cases of free-floating thrombus in the IA treated at our institution with 3 different approaches. CASES The first case is a patient with a free-floating thrombus in the IA treated with cervical debranching and ligation of the proximal right carotid artery; another case of a patient treated with a hybrid approach with deployment of an iliac limb in the IA plus right carotid to subclavian bypass; and a third case of a patient operated by open arch thrombectomy. CONCLUSIONS Free-floating thrombus in the IA is a threatening condition feasible to be managed through different customized surgical approaches in specialized centers.
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Affiliation(s)
- Jose Ignacio Torrealba
- Department of Vascular Surgery, 28033Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco J Valdés
- Department of Vascular Surgery, 28033Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Garrido
- Department of Cardiac Surgery, 28033Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Renato Mertens
- Department of Vascular Surgery, 28033Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Leopoldo Mariné
- Department of Vascular Surgery, 28033Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Michel Bergoeing
- Department of Vascular Surgery, 28033Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Vargas
- Department of Vascular Surgery, 28033Pontificia Universidad Católica de Chile, Santiago, Chile
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3
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Jeon BH, Lee CH, Bae CH, Jang JS, Cho JW. Surgical Treatment of an Innominate Artery Aneurysm Using Near-Infrared Spectroscopy for Cerebral Monitoring: A Case Report. J Chest Surg 2021; 54:517-520. [PMID: 34667133 PMCID: PMC8646058 DOI: 10.5090/jcs.21.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/29/2021] [Accepted: 06/03/2021] [Indexed: 11/23/2022] Open
Abstract
Innominate artery aneurysms are challenging for surgeons to treat because of the requirement for brain protection during surgery. In innominate artery aneurysms, the endovascular approach does not require cardiopulmonary bypass, but patients who can be treated using this approach are limited in number, and the long-term results of endovascular treatment are unclear. Here, we report our experience of successfully treating a patient with an innominate artery aneurysm using near-infrared spectroscopy without cardiopulmonary bypass support or hypothermic circulatory arrest.
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Affiliation(s)
- Byeng Hun Jeon
- Department of Thoracic and Cardiovascular Surgery, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Chul Ho Lee
- Department of Thoracic and Cardiovascular Surgery, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Chi Hoon Bae
- Department of Thoracic and Cardiovascular Surgery, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Jae Seok Jang
- Department of Thoracic and Cardiovascular Surgery, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Jun Woo Cho
- Department of Thoracic and Cardiovascular Surgery, Daegu Catholic University School of Medicine, Daegu, Korea
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O'Malley TJ, Jordan AM, Prochno KW, Saxena A, Maynes EJ, Ferrell B, Guy TS, Entwistle JW, Massey HT, Morris RJ, Abai B, Tchantchaleishvili V. Evaluation of Endovascular Intervention for Tracheo-Innominate Artery Fistula: A Systematic Review. Vasc Endovascular Surg 2021; 55:317-324. [PMID: 33529132 DOI: 10.1177/1538574420980625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND While the standard of care for suspected tracheo-innominate artery fistula (TIF) necessitates sternotomy, perioperative mortality remains high. Endovascular interventions have been attempted, but reports have been anecdotal. The aim of this systematic review was to evaluate the outcomes of endovascular management of TIF by pooling the existing evidence. METHODS An electronic database search of Ovid MEDLINE, Scopus, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Controlled Trials Register was performed to identify all studies examining endovascular treatment of TIF. Patients greater than 14 years of age who underwent endovascular intervention for TIF were included. 25 studies consisting of 27 patients met the inclusion criteria. RESULTS 48.1% (13/27) of patients were male and median age was 39.0 [IQR 16.0, 47.5] years. Tracheostomy was present in 96.3% (26/27) of cases. Median duration from tracheostomy to TIF presentation was 2.2 months [0.5, 42.5]. On presentation, 84.6% (22/26) had tracheal hemorrhage, and 22.8% (6/27) were hemodynamically unstable. 96.3% (26/27) underwent covered stent graft placement while 1 patient (3.8%) had coil embolization. 18.5% (5/27) of patients required repeat endovascular intervention for recurrent bleeding, while 11.1% (3/27) required rescue sternotomy. Median hospital length of stay was 30 days [16.0, 46.5], and overall mortality was 29.6% (8/27) with a median follow-up time of 5 months [1.2, 11.5]. CONCLUSION While uncommon, endovascular treatment of TIF may be a feasible alternative to sternotomy. The approach may be useful in those who are unable to undergo surgery or are likely to have adhesions from prior chest operations.
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Affiliation(s)
- Thomas J O'Malley
- Division of Cardiac Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrew M Jordan
- Division of Cardiac Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
| | - Kyle W Prochno
- Division of Cardiac Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
| | - Abhiraj Saxena
- Division of Cardiac Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
| | - Elizabeth J Maynes
- Division of Cardiac Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
| | - Brandon Ferrell
- 12230Georgetown University School of Medicine, Washington, DC, USA
| | - T Sloane Guy
- Division of Cardiac Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
| | - John W Entwistle
- Division of Cardiac Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
| | - H Todd Massey
- Division of Cardiac Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
| | - Rohinton J Morris
- Division of Cardiac Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
| | - Babak Abai
- Division of Vascular and Endovascular Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
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5
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Ammi M, Henni S, Salomon Du Mont L, Settembre N, Loubiere H, Sobocinski J, Gouëffic Y, Feugier P, Duprey A, Martinez R, Bartoli M, Coscas R, Chaufour X, Kaladji A, Rosset E, Abraham P, Picquet J. Lower Rate of Restenosis and Reinterventions With Covered vs Bare Metal Stents Following Innominate Artery Stenting. J Endovasc Ther 2019; 26:385-390. [DOI: 10.1177/1526602819838867] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Purpose: To determine any difference between bare metal stents (BMS) and balloon-expandable covered stents in the treatment of innominate artery atheromatous lesions. Materials and Methods: A multicenter retrospective study involving 13 university hospitals in France collected 93 patients (mean age 63.2±11.1 years; 57 men) treated over a 10-year period. All patients had systolic blood pressure asymmetry >15 mm Hg and were either asymptomatic (39, 42%) or had carotid (20, 22%), vertebrobasilar (24, 26%), and/or brachial (20, 22%) symptoms. Innominate artery stenosis ranged from 50% to 70% in 4 (4%) symptomatic cases and between 70% and 90% in 52 (56%) cases; 28 (30%) lesions were preocclusive and 8 (9%) were occluded. One (1%) severely symptomatic patient had a <50% stenosis. Demographic characteristics, operative indications, and procedure details were compared between the covered (36, 39%) and BMS (57, 61%) groups. Multivariate analysis was performed to determine relative risks of restenosis and reinterventions [reported with 95% confidence intervals (CI)]. Results: The endovascular procedures were performed mainly via retrograde carotid access (75, 81%). Perioperative strokes occurred in 4 (4.3%) patients. During the mean 34.5±31.2–month follow-up, 30 (32%) restenoses were detected and 13 (20%) reinterventions were performed. Relative risks were 6.9 (95% CI 2.2 to 22.2, p=0.001) for restenosis and 14.6 (95% CI 1.8 to 120.8, p=0.004) for reinterventions between BMS and covered stents. The severity of the treated lesions had no influence on the results. Conclusion: Patients treated with BMS for innominate artery stenosis have more frequent restenoses and reinterventions than patients treated with covered stents.
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Affiliation(s)
- Myriam Ammi
- Service de Chirurgie Vasculaire, CHU Angers, France
| | - Samir Henni
- Service de Médecine Vasculaire, CHU Angers, France
| | | | | | | | | | | | | | | | | | - Michel Bartoli
- Service de Chirurgie Vasculaire, Assistance Publique–Hôpitaux de Marseille, France
| | - Raphael Coscas
- Service de Chirurgie Vasculaire, Hôpital Ambroise Paré, Paris, France
| | | | | | - Eugenio Rosset
- Service de Chirurgie Vasculaire, CHU Clermont Ferrand, France
| | | | - Jean Picquet
- Service de Chirurgie Vasculaire, CHU Angers, France
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6
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Brownstein AJ, Rajaee S, Erben Y, Li Y, Rizzo JA, Lyall V, Mojibian H, Ziganshin BA, Elefteriades JA. Natural history of aneurysmal aortic arch branch vessels in a single tertiary referral center. J Vasc Surg 2018; 68:1631-1639.e1. [DOI: 10.1016/j.jvs.2018.03.412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/30/2018] [Indexed: 12/19/2022]
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7
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Howe KL, Guirgis M, Woodman G, Victor Chu F, Cooper MJ, Rapanos T, Szalay D. Blunt innominate artery trauma requiring repair and carotid ligation. Trauma Case Rep 2018; 12:24-27. [PMID: 29644279 PMCID: PMC5887091 DOI: 10.1016/j.tcr.2017.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2017] [Indexed: 11/25/2022] Open
Abstract
Traumatic dissection of the innominate artery is a rare clinical entity. Management of a patient with motorsensory compromise and dissection extending to the subclavian and right common carotid arteries is quite rare and can be quite involved. Here we present such a case and discuss the unique peri-operative decision-making in the context of what is reported in the literature. Restoration of motorsensory function is critical and in this case, requiring a multi-disciplinary team.
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Affiliation(s)
- Kathryn L Howe
- Division of Vascular Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mina Guirgis
- Division of Vascular Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Grant Woodman
- Division of Vascular Surgery, McMaster University, Hamilton, Ontario, Canada
| | - F Victor Chu
- Division of Cardiac Surgery, McMaster University, Hamilton, Ontario, Canada
| | - M J Cooper
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Theodore Rapanos
- Division of Vascular Surgery, McMaster University, Hamilton, Ontario, Canada
| | - David Szalay
- Division of Vascular Surgery, McMaster University, Hamilton, Ontario, Canada
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8
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Troutman DA, Dougherty MJ, Spivack AI, Calligaro KD. Stent Graft Placement for a Tracheoinnominate Artery Fistula. Ann Vasc Surg 2014; 28:1037.e21-4. [DOI: 10.1016/j.avsg.2013.08.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 08/16/2013] [Accepted: 08/20/2013] [Indexed: 11/24/2022]
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9
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Al-Natour M, Renno A, El-Fedaly M, Abbas J, Nazzal M. Stent fracture in the brachiocephalic trunk. Vascular 2013; 21:261-5. [DOI: 10.1177/1708538113478775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stents are commonly used as a tool for revascularization of different vascular beds in the body. However, many pitfalls have been reported with their use, such as thrombosis, migration, restenosis or fractures. The latter have been strongly correlated to in-stent restenosis with long-term follow-up. We report a rare case of an early stent fracture in the brachiocephalic trunk with in-stent restenosis and recurrence of symptoms. To our knowledge there has been only one case report of a delayed brachiocephalic stent fracture in the English literature. We believe that our case is the first report of an early stent fracture in the brachiocephalic trunk.
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Affiliation(s)
- M Al-Natour
- Division of Vascular and Endovascular Surgery, The University of Toledo Medical Center, Toledo, OH, USA
| | - A Renno
- Division of Vascular and Endovascular Surgery, The University of Toledo Medical Center, Toledo, OH, USA
| | - M El-Fedaly
- Division of Vascular and Endovascular Surgery, The University of Toledo Medical Center, Toledo, OH, USA
| | - J Abbas
- Division of Vascular and Endovascular Surgery, The University of Toledo Medical Center, Toledo, OH, USA
| | - M Nazzal
- Division of Vascular and Endovascular Surgery, The University of Toledo Medical Center, Toledo, OH, USA
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10
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Constenla I, Alvarez B, Yugueros X, Fernandez E, Bofill R, Matas M. Innominate artery aneurysm with hemoptysis and airway compression in a patient with bovine aortic arch. J Vasc Surg 2012; 56:822-5. [PMID: 22727838 DOI: 10.1016/j.jvs.2012.03.241] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 03/12/2012] [Accepted: 03/13/2012] [Indexed: 11/30/2022]
Abstract
We present the case of a 63-year-old man with a bovine aortic arch variation, who presented episodes of mild hemoptysis secondary to a 4.5-cm (diameter) aneurysm of the innominate artery that compressed the trachea and obliterated the right subclavian artery. Surgery, performed through a median sternotomy, consisted of a bypass from the ascending aorta to both common carotid arteries using a Dacron graft, and exclusion of the aneurysm by ligature and direct thrombin injection. Computed tomography angiography at 30 days showed a patent bypass, successful aneurysm exclusion, and improvement of the tracheal compression. The patient is currently asymptomatic at 12 months following the procedure.
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Affiliation(s)
- Iván Constenla
- Section of Vascular and Endovascular Surgery, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
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11
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Angiletta D, Marinazzo D, Guido G, Fullone M, Pulli R, Regina G. Eight-year follow-up of endovascular repair of a brachiocephalic trunk aneurysm due to Takayasu's arteritis. J Vasc Surg 2012; 56:504-7. [PMID: 22554423 DOI: 10.1016/j.jvs.2012.02.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Revised: 02/07/2012] [Accepted: 02/09/2012] [Indexed: 10/28/2022]
Abstract
Aneurysms of the brachiocephalic trunk are rare but their clinical outcomes are potentially devastating; they include rupture, cerebral or arm ischemia secondary to thromboembolism, and compression of the surrounding structures. Although open repair has proven successful, it is associated with significant morbidity and mortality rates. Endovascular treatment, if anatomically feasible, may offer a safer and less invasive approach to these lesions, especially in high-surgical-risk patients. We report the good long-term outcome of endovascular repair of a large innominate artery true aneurysm due to Takayasu's arteritis. A stent graft was safely and successfully deployed to exclude the aneurysm; assessment by vascular imaging at 8-year follow-up demonstrated the efficacy of the procedure.
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Affiliation(s)
- Domenico Angiletta
- Department of Vascular and Endovascular Surgery, University of Bari, Bari, Italy
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12
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Isolated dissecting aneurysm of the brachiocephalic artery associated with contained rupture. Gen Thorac Cardiovasc Surg 2012; 60:225-7. [PMID: 22451145 DOI: 10.1007/s11748-011-0809-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 03/31/2011] [Indexed: 10/28/2022]
Abstract
A 79-year-old man with no history of trauma complained of a sudden onset of headache and backache. Computed tomography showed an isolated dissecting aneurysm 4 cm in diameter associated with contained rupture at the takeoff region of the brachiocephalic artery. Surgery was performed on an emergent basis. The proximal aortic arch was successfully replaced using antegrade selective cerebral perfusion. The patient was easily weaned from cardiopulmonary bypass and recovered uneventfully.
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13
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Nemes B. New possibilities in the endovascular treatment of supraaortic vessels. Interv Med Appl Sci 2011. [DOI: 10.1556/imas.3.2011.4.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Cerebrovascular disease, including stroke, represents the third-leading cause of death in Hungary and a leading cause of disability among the elderly population. The majority of all strokes are ischemic, mostly secondary to thromboembolic disease of the supraaortic vessels. We investigated new therapeutic methods in the endovascular treatment of these diseases. Surgical revascularization of supraaortic trunk stenosis is associated with high morbidity and mortality rates. Balloon angioplasty has become an increasingly accepted treatment of stenoocclusive supraaortic arterial disease. Natural history data and treatment guidelines do not exist for innominate and proximal common carotid artery lesions. We have confirmed in a large series of innominate artery angioplasties that it is a safe and effective procedure with an excellent initial success rate, with a lower complication rate than the surgical option and with a similar long-term patency rate as for surgery.
In the largest published study on transfemoral angioplasty of ostial and proximal common carotid artery stenosis we have proved that endovascular treatment has high success rate with low stroke/death rate. Carotid stenting (CAS) is an evolving alternative to surgery in the treatment of patients with carotid stenosis. Stent selection is influenced by several factors, including the carotid anatomy and lesion characteristics. We examined the wall adaptability of a new closed-cell carotid stent (NexStent), which was designed for carotid bifurcation treatment. Data obtained from angiographic and computed tomographic images indicate that the stent provides adequate expansion and adaptation to the carotid bifurcation.
There are two types of restenosis after carotid artery interventions: the early restenosis develops mainly within the first 24 months after the revascularization procedure and its pathological background is myointimal hyperplasia; on the other hand late restenosis is rather due to progression of primary atherosclerosis and occurs more than 2 years after carotid endarterectomy (CEA). We compared the early restenosis rate in a consecutive series of CAS versus CEA patients at a single cardiovascular institution. The data suggest that the incidence of restenosis after stenting was less common than after surgery.
Our results may help vascular surgeons and interventional radiologists to consider risk versus benefit when deciding treatment options for supraaortic arterial stenosis.
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Affiliation(s)
- Balázs Nemes
- 1 Heart Center, Semmelweis University, Városmajor u. 68, H-1122, Budapest, Hungary
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14
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Ullery BW, Foley PJ, Brinster CJ, Pochettino A, Fairman RM. A novel two-stage surgical approach for the treatment of symptomatic supra-aortic artery aneurysms. Vascular 2011; 20:236-40. [PMID: 22030356 DOI: 10.1258/vasc.2011.cr0287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We describe the case of a 45-year-old man with a unique constellation of supra-aortic artery aneurysms detected by chest X-ray during work-up for chronic cough. During his diagnostic work-up, the patient suffered an embolic stroke likely secondary to disrupted plaque originating in an aneurysmal right vertebral artery. Endovascular repair was not a viable option due to the diffuse and bilateral nature of aneurysmal disease, including involvement of the innominate and right carotid and vertebral arteries. The patient was successfully treated with a two-stage open surgical approach involving an initial right carotid artery to vertebral artery bypass and subsequent in situ reconstruction utilizing a bifurcated Dacron graft sewn to the proximal aortic arch with distal extension to the right common carotid and axillary arteries.
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Affiliation(s)
| | - Paul J Foley
- Division of Vascular Surgery and Endovascular Therapy
| | | | - Alberto Pochettino
- Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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15
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Paukovits TM, Nemes B, Hüttl K, Bérczi V. [Percutaneous, endovascular treatment of innominate artery lesions is a safe and effective procedure]. Orv Hetil 2011; 152:1745-50. [PMID: 21983401 DOI: 10.1556/oh.2011.29221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Percutaneous endovascular treatment (transluminar balloon angioplasty with or without stent implantation) of innominate artery lesions has become the treatment of choice prior to surgery in the past decades. Authors present the diagnostics, treatment and follow-up of two patients as examples from their largest series in the literature. A 74-year-old male patient with a history of hyperlipidemia, hypertension, nicotine abuse and lower limb claudication was admitted because of acute upper limb claudication and dizziness. Physical examination revealed blood pressure difference of 30 mmHg between his arms, and poststenotic flow pattern in the common carotid artery with retrograde flow in the vertebral artery on carotid duplex scan. Diagnostic angiography showed 80% stenosis of the innominate artery, which was treated with percutaneous transluminar balloon angioplasty with stent implantation. Follow-up examination at 5 months showed no significant restenosis or neurological complication. The second patient was a 59-year-old smoker female patient with hypertension and type 2 diabetes mellitus, who was evaluated for her upper limb claudication. Initial finding was the absence of radial pulse in the right side. Color duplex scan revealed proximal subocclusion, which was confirmed by angiography. In one stage, balloon angioplasty was made, with immediate pain relief. After 15 months the patient was symptom-free. These two cases demonstrate an excellent outcome of endovascular treatment of innominate artery lesions, as authors already reported in two retrospective studies. Balloon angioplasty with, or without stent deployment appears to be a safe procedure with excellent primary success rate. Review of international studies also indicates that endovascular therapy of the innominate artery is safe and effective.
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Affiliation(s)
- Tamás Mirkó Paukovits
- Semmelweis Egyetem, Általános Orvostudományi Kar Cardiovascularis Centrum Budapest Gál József u. 9. 1122.
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16
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Endovascular and Open Surgical Treatment of Brachiocephalic Arteries. Ann Vasc Surg 2011; 25:569-81. [DOI: 10.1016/j.avsg.2010.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 10/15/2010] [Accepted: 10/17/2010] [Indexed: 11/19/2022]
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17
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Chang J, Stein T, Siegel D, Rosca M. Endovascular repair of innominate artery true aneurysm with extra-anatomic revascularization of right carotid and vertebral arteries — A case report. Int J Angiol 2011. [DOI: 10.1007/s00547-005-8051-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Chang J, Stein T, Siegel D, Rosca M. Endovascular repair of innominate artery true aneurysm with extra-anatomic revascularization of right carotid and vertebral arteries — A case report. Int J Angiol 2011. [DOI: 10.1007/s00547-005-2051-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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19
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Mohr J, Caplan LR. Vertebrobasilar Disease. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10026-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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20
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Percutaneous Endovascular Treatment of Innominate Artery Lesions: A Single-centre Experience on 77 Lesions. Eur J Vasc Endovasc Surg 2010; 40:35-43. [DOI: 10.1016/j.ejvs.2010.03.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Accepted: 03/12/2010] [Indexed: 11/22/2022]
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21
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Fawcett SL, Gomez AC, Hughes JA, Set P. Anatomical variation in the position of the brachiocephalic trunk (innominate artery) with respect to the trachea: a computed tomography-based study and literature review of Innominate Artery Compression Syndrome. Clin Anat 2010; 23:61-9. [PMID: 19918870 DOI: 10.1002/ca.20884] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Respiratory compromise due to tracheal compression by the brachiocephalic trunk (BT), a condition first labeled as Innominate Artery Compression Syndrome (IACS), has been controversially attributed to an anomalous origin of this vessel to the left of, and hence crossing, the trachea. The aim of this study was to establish the normal relationship between the BT and trachea in infants, children, and young adults without obstructive respiratory symptoms. One hundred and eighty-one computed tomography (CT) examinations of the thorax, in three age groups, were reviewed. In axial cross section, the origin of the BT from the aortic arch was identified. The BT origin, with respect to the trachea, was recorded as for a clock face, approximated to the nearest half hour. There were 62 CTs in Group 1 (1 day to 3 years of age), 48 CTs in Group 2 (10-15 years), and 71 examinations in Group 3 (20-40 years). In 96.8% of Group 1, 91.7% of Group 2, and 74.6% of Group 3 the BT origin was to the left of the trachea, between the half past twelve and 3 o'clock positions. The BT origin occurred more the left in Group 1 when compared with the other two groups (P < 0.001). An origin of the BT to the left of the trachea is a normal finding in children and young adults without obstructive respiratory symptoms. There is a tendency for the origin to become progressively more rightward with age.
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Affiliation(s)
- S L Fawcett
- Department of Radiology, Cambridge University Teaching Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom.
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22
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Bourgouin S, Hornez E, Monchal T, Baudoin Y, Meyrat L, Thouard H. [Is emergency revascularization of tracheo-innominate artery fistulae mandatory?]. JOURNAL DES MALADIES VASCULAIRES 2010; 35:38-42. [PMID: 19959305 DOI: 10.1016/j.jmv.2009.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 10/13/2009] [Indexed: 05/28/2023]
Abstract
Tracheo-innominate artery fistulas are a rare but life-threatening complications (incidence between 0.1 and 1 %) occurring in tracheostomy patients. Surgery is the treatment of choice. Most authors recommend ligation of the innominate artery, which provides better results in terms of morbidity/mortality than revascularization surgery. We report here a case of innominate artery revascularization isolated from the trachea by a sternocleidomastoid pediculate interposition graft. The procedure was successful as demonstrated by the 2 years follow-up. Revascularization surgery should be reserved of specific cases. The risk of tracheal-mediated infections developing in contact with the vascular sutures warrants systematic use of an interposition graft isolating the trachea from the innominate artery.
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Affiliation(s)
- S Bourgouin
- Service de chirurgie viscérale et vasculaire, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, BP 20545, 83041 Toulon cedex 09, France. stephane
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23
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Lampropoulos S, Theofilogiannakos EK, Gkontopoulos A, Kadoglou NP, Mamalis V, Kontaki T, Kottas G. Syncope and cardiovocal syndrome as the result of a spontaneous innominate artery dissection. J Cardiovasc Med (Hagerstown) 2009; 10:815-7. [DOI: 10.2459/jcm.0b013e32832d2f31] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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24
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Cury M, Greenberg RK, Morales JP, Mohabbat W, Hernandez AV. Supra-aortic vessels aneurysms: diagnosis and prompt intervention. J Vasc Surg 2009; 49:4-10. [PMID: 19174249 DOI: 10.1016/j.jvs.2008.08.088] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Revised: 08/25/2008] [Accepted: 08/27/2008] [Indexed: 11/16/2022]
Abstract
PURPOSE Aneurysms involving the supra-aortic vessels are rare but carry serious risk of embolization, thrombosis, and rupture. We describe our experience with the diagnosis, treatment strategies, and outcomes in patients with extended follow-up. METHODS Data during a 17-year period (January 1990 to December 2007) was analyzed. We assessed age, gender, presenting symptoms, localization, pathologic diagnosis, type of procedures, complications, and survival. RESULTS A total of 74 patients were treated for supra-aortic aneurysms. Of all aneurysms treated, 63% were degenerative, 24% iatrogenic, 8% traumatic, 3% genetic, and 1% mycotic. The subclavian artery was most commonly affected (50%, 2/3 in the right side), followed by the common carotid (36%), internal carotid (10%), innominate (3%), and vertebral (1%). At the time of diagnosis, 52 patients (70%) were asymptomatic, but of those symptomatic 68% had an embolic event as a presenting symptom. Embolic episodes were more common in patients with smaller aneurysms (P < .006). Open surgery was performed in 77% of all cases, and the use of endovascular techniques became the predominant treatment modality over the last 4 years. Survival at 30 days was 100%. Five- and 10-year survival rates were 87% and 43%, respectively. CONCLUSION Most cases of supra-aortic aneurysm are asymptomatic and embolization as opposed to rupture represents the greatest risk to the patient. Most cases can be detected prior to symptoms. Endovascular repair is an emerging alternative of treatment and, with the current development of appropriate devices, will likely form the mainstay of therapy in the near future.
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Affiliation(s)
- Marcelo Cury
- Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Cohen JE, Klimov A, Rajz G, Paldor I, Spektor S. Exsanguinating tracheoinnominate artery fistula repaired with endovascular stent-graft. ACTA ACUST UNITED AC 2008; 69:306-9. [PMID: 17586021 DOI: 10.1016/j.surneu.2006.12.060] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Accepted: 12/27/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Tracheoinnominate artery fistula is a relatively rare but life-threatening complication of tracheostomy. Peristomal bleed or hemoptysis may be massive and usually fatal if treatment is not instituted immediately. CASE DESCRIPTION We report the case of a 40-year-old woman who sustained surgical evacuation of a brainstem cavernoma and developed a massive hemoptysis 13 days after a percutaneous tracheostomy. Because of the patient's poor clinical condition, endovascular repair of the arterial injury was decided. The innominate artery was successfully repaired by means of urgent stent-graft placement. CONCLUSIONS We believe that, if technically feasible, stent-graft placement can be a valuable therapeutic alternative for this dramatic condition. Physicians in charge of tracheostomized patients and neurointerventionalists should be familiar with this management strategy.
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Affiliation(s)
- José E Cohen
- Department of Neurosurgery, Hadassah Hebrew University Hospital, 91120 Jerusalem, Israel.
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26
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Abstract
Innominate artery may cross the trachea and cause airway obstruction is a rare cause of vascular obstruction of airway. We describe a child with stridor, inability to extubate in whom the diagnosis was suspected on fluoroscopy and confirmed by angiography. Reimplantation of the innominate artery resulted in excellent results with longterm follow up. Variantions of this condition and modalities for confirmation of diagnosis are discussed.
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Affiliation(s)
- Manvinder Singh Sachdev
- Department of Pediatrics, Pediatric Cardiology & Congenital Cardiac Surgery Unit, Neonatal Intensive Care Unit*, Indraprastha Apollo Hospital, New Delhi, India
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27
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Nakano L, Wolosker N, Rosoki RA, Netto BM, Puech-Leão P. Objective evaluation of upper limb claudication: use of isokinetic dynamometry. Clinics (Sao Paulo) 2006; 61:189-96. [PMID: 16832550 DOI: 10.1590/s1807-59322006000300002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The objective of this work is to present an objective, practical, and reproducible method for evaluating the functional limitation caused by occlusive arterial disease in upper limbs: a stress test using an isokinetic dynamometer. METHODS Twenty-three patients with unilateral subclavian artery occlusive disease were included in the study, forming group 1. Seven patients of similar age, with atherosclerotic or Takayasu's disease in the aorto-iliac segment, without subclavian artery occlusive disease, were included as a control group (group 2). For all tests, we utilized the CYBEX 6000 isokinetic dynamometer. The elbow was tested using a series of 30 repetitions of extension and flexion of the arm, performed up to a maximum of 270 repetitions (9 series) or until the limit of the tested limb was reached. RESULTS We initially compared all the limbs without arterial disease of both groups to analyze whether they presented similar functional performance. No significant difference was found for any of the parameters studied. Considering that upper limbs without arterial disease have a similar response to exercise in these analyzed parameters, we compared the upper limbs in group 1 (with and without subclavian artery occlusive disease). For all parameters, the limbs with subclavian artery occlusive disease presented significantly lower values than the control limbs (P < 0.05), which can be objectively attributed to the ischemia (there were different responses in different individuals, which allows the quantification of the limitation caused by subclavian artery occlusive disease). CONCLUSION In this study, we present a new stress test for impairment in patients with subclavian artery occlusive disease that might facilitate the classification of patients according to their functional impairment, and thus result in a better choice of therapeutic approach for each case as well as reporting of objective parameters that allow comparisons of the results of different treatments, including for long-term follow-up.
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Affiliation(s)
- Lívio Nakano
- Department of Vascular Surgery, São Paulo University Medical School, Brazil.
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Grant CA, Dempsey G, Harrison J, Jones T. Tracheo-innominate artery fistula after percutaneous tracheostomy: three case reports and a clinical review. Br J Anaesth 2005; 96:127-31. [PMID: 16299043 DOI: 10.1093/bja/aei282] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Tracheo-innominate artery fistula (TIF) is an uncommon yet life threatening complication after a tracheostomy. Rates of 0.1-1% after surgical tracheostomy have been reported, with a peak incidence at 7-14 days post procedure. It is usually fatal unless treatment is instituted immediately. Initial case reports of TIF resulted from surgically performed tracheostomies. We present three fatalities attributable to TIF, confirmed by histopathology, after percutaneous dilatational tracheostomy (PDT). The use of PDT has resulted in tracheostomies being performed by specialists from different backgrounds and the incidence of this complication may be increasing. Pressure necrosis from high cuff pressure, mucosal trauma from malpositioned cannula tip, low tracheal incision, radiotherapy and prolonged intubation are all implicated in TIF formation. Massive haemorrhage occurring 3 days to 6 weeks after tracheostomy is a result of TIF until proven otherwise. We present a simple algorithm for management of this situation. The manoeuvres outlined will control bleeding in more than 80% of patients by a direct tamponade effect. Surgical stasis is obtained by debriding the innominate artery proximally, then transecting and closing the lumen. Neurological sequelae are few. Post-mortem diagnosis of TIF may be difficult, but specific pathology request should be made to assess innominate artery abnormalities.
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Affiliation(s)
- C A Grant
- Critical Care Unit, University Hospital, Aintree, Liverpool, UK.
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29
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Thorp A, Hurt TL, Kim TY, Brown L. Tracheoinnominate artery fistula: a rare and often fatal complication of indwelling tracheostomy tubes. Pediatr Emerg Care 2005; 21:763-6. [PMID: 16280953 DOI: 10.1097/01.pec.0000186433.82085.f6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Fistula formation between the innominate artery and the trachea is a rare but potentially catastrophic complication after tracheostomy. Although surgery is the definitive treatment of tracheoinnominate artery fistula, the responsibility for making the proper diagnosis and stabilizing the patient before surgery often falls on the personnel in the emergency department. We describe the emergency department management of a 14-year-old girl with a tracheoinnominate artery fistula. A discussion of the risk factors, diagnostic considerations, and emergency department management strategies of tracheoinnominate artery fistula is presented.
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Affiliation(s)
- Andrea Thorp
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, Loma Linda, CA 92354, USA.
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30
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Takach TJ, Reul GJ, Cooley DA, Duncan JM, Livesay JJ, Gregoric ID, Krajcer Z, Cervera RD, Ott DA, Frazier OH. Brachiocephalic reconstruction I: Operative and long-term results for complex disease. J Vasc Surg 2005; 42:47-54. [PMID: 16012451 DOI: 10.1016/j.jvs.2005.03.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Complex brachiocephalic disease involves multiple vessels and is frequently associated with multisystem atherosclerosis. We reviewed surgical outcome and examined the impact of this problem on decision making regarding operative staging, technique, and choice of conduit. METHODS Between 1966 and 2000, 157 consecutive patients (mean age, 54.0 years; 48.4% male) with innominate artery or multivessel brachiocephalic disease underwent operative reconstruction using either a transthoracic approach (group A, n = 113) or a less invasive, extrathoracic approach (group B, n = 44). Reconstruction required multiple distal anastomoses in 70 patients (44.6%), concomitant coronary artery bypass grafting (CABG) in 37 patients (23.6%), and concomitant carotid endarterectomy (CEA) in 26 patients (16.6%). RESULTS No significant differences were found between group A and group B when operative mortality (2.7% vs 2.3%) and stroke rates (2.7% vs 6.8%) were analyzed. However, 10 years after surgery, freedom from graft failure was significantly better in group A (94.4% +/- 4.4%) than in group B (60.3% +/- 13.4%) ( P = .002). Freedom from graft failure was adversely affected by nonaortic inflow ( P = .002) and axillo-axillary cervical grafts ( P = .0001). Mortality and stroke rates for subgroups having multiple distal anastomoses (2.9%, 2/70 and 4.3%, 3/70), concomitant CABG (5.4%, 2/37 and 0, 0/37), and concomitant CEA (3.8%, 1/26 and 3.8%, 1/26) were similar to those of other patients. For the entire patient group, 10-year rates of actuarial freedom from specific events were death, 68.8% +/- 6.0%; myocardial infarction, 86.7% +/- 4.5%; stroke, 87.0% +/- 4.4%; coronary revascularization, 88.0% +/- 3.6%, and other vascular operation, 79.9% +/- 4.4%. CONCLUSIONS Transthoracic arch reconstruction for complex brachiocephalic disease can be done with acceptably low morbidity and mortality similar to those of a less invasive, extrathoracic approach. Furthermore, the transthoracic approach is associated with significantly better long-term freedom from graft failure, possibly because it preserves aortic inflow to the great vessels. Nonetheless, the high frequency of late events in this relatively young patient population reflects the presence of multisystem atherosclerosis and suggests the need for close follow-up and lifestyle modification.
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Affiliation(s)
- Thomas J Takach
- Department of Cardiovascular Surgery, Texas Heart Institute, Houston, 77225, USA
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31
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Caplan L, Wityk R, Pazdera L, Chang HM, Pessin M, Dewitt L. New England Medical Center Posterior Circulation Stroke Registry II. Vascular Lesions. J Clin Neurol 2005; 1:31-49. [PMID: 20396470 PMCID: PMC2854929 DOI: 10.3988/jcn.2005.1.1.31] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Accepted: 03/12/2005] [Indexed: 01/27/2023] Open
Abstract
Among 407 New England Medical Center Posterior Circulation Registry (NEMC-PCR) patients, the extracranial (ECVA) and intracranial vertebral arteries (ICVA) were the commonest sites of severe occlusive disease followed by the basilar artery (BA). Severe occlusive lesions were found in >1 large artery in 148 patients; 134 had unilateral or bilateral severe disease at one arterial location. Single arterial site occlusive disease occurred most often in the ECVA (52 patients, 15 bilateral) followed by the ICVA (40 patients, 12 bilateral) and the BA (46 patients). Involvement of the ICVAs and the BA was very common and some patients also had ECVA lesions. Hypertension, smoking, and coronary and peripheral vascular disease were most prevalent in patients with extracranial disease while diabetes and hyperlipidemia were more common when occlusive lesions were only intracranial. Intra-arterial embolism was the most common mechanism of brain infarction in patients with ECVA and ICVA occlusive disease. ICVA occlusive lesions infrequently caused infarction limited to the proximal territory (medulla and posterior inferior cerebellum). BA lesions most often caused infarcts limited to the middle posterior circulation territory (pons and anterior inferior cerebellum). Posterior cerebral artery occlusive lesions were predominantly embolic. Penetrating artery disease caused mostly pontine and thalamic infarcts. Prognosis was poorest in patients with BA disease. The best prognosis surprisingly was in patients who had multiple arterial occlusive lesions; they often had position-sensitive transient ischemic attacks during months or years.
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Affiliation(s)
- Lr Caplan
- Cerebrovascular Disease Sections of the New England Medical Center, Boston and the Beth Israel Deaconess Medical Center, Boston
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32
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de Feiter PW, van Mook WNKA, Jacobs MJHM. Tracheal compression caused by an innominate artery aneurysm after thoracic aortic aneurysm repair in a patient with Marfan disease. J Thorac Cardiovasc Surg 2005; 129:943-4. [PMID: 15821671 DOI: 10.1016/j.jtcvs.2004.08.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- P W de Feiter
- Department of Surgery, University Hospital Maastricht, Maastricht, The Netherlands.
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Takaba K, Aota M, Koike H, Konishi Y. Surgical treatment for intrathoracic aneurysm of the innominate artery in an 83-year-old asymptomatic woman. ACTA ACUST UNITED AC 2004; 52:194-7. [PMID: 15141709 DOI: 10.1007/s11748-004-0107-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Aneurysm of the innominate artery is uncommon compared with other peripheral aneurysms, and holds the potential for rupture, embolization, or thrombosis as well as various complications caused by compression to the adjacent structures. The most effective treatment for this condition is surgical resection, but the earlier reports described high mortality rates. We report the case of an 83-year-old asymptomatic woman with an aneurysm in the innominate artery, which was successfully resected and repaired with the use of modern surgical techniques of hypothermic circulatory arrest and selective cerebral perfusion. Aggressive surgical intervention should be employed despite the fact that a patients is asymptomatic.
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Affiliation(s)
- Kiyoaki Takaba
- Department of Cardiovascular Surgery, Japanese Red Cross Society Wakayama Medical Center, 4-20 Komatsubaradouri, Wakayama 640-8558, Japan
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Biebl M, Neuhauser B, Perkmann R, Tauscher T, Waldenberger P, Fraedrich G. Traumatic Pseudoaneurysm of the Brachiocephalic Artery following Medianoscopy: Initial Endovascular Repair Followed by Open Surgery—A Case Report. Am Surg 2003. [DOI: 10.1177/000313480306900619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Endovascular stent graft repair of traumatic vessel injuries is gaining worldwide acceptance as a minimally invasive alternative to open surgical repair. However, effective endovascular repair fails if the aneurysm is not completely excluded. Conversion to open surgery may be unavoidable in such cases. Herein we describe the case of a 45-year-old man who was referred to our hospital with a pseudoaneurysm of the proximal brachiocephalic artery caused by biopsy during diagnostic medianoscopy. The pseudoaneurysm was primarily treated by stent-graft implantation into the proximal brachiocephalic artery. As a result of the unfavorable location of the lesion exclusion of the aneurysm failed and the initial therapy had to be extended to open reconstruction of the brachiocephalic artery. A bypass procedure from the aortic arch to the right common carotid artery was performed with reinsertion of the right subclavian artery to exclude the pseudoaneurysm.
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Affiliation(s)
- Matthias Biebl
- Departments of Vascular Surgery, University Hospital Innsbruck, Austria
| | - B. Neuhauser
- Departments of Vascular Surgery, University Hospital Innsbruck, Austria
| | - R. Perkmann
- Departments of Vascular Surgery, University Hospital Innsbruck, Austria
| | - T. Tauscher
- Departments of Vascular Surgery, University Hospital Innsbruck, Austria
| | - P. Waldenberger
- Department of Radiology, University Hospital Innsbruck, Austria
| | - G. Fraedrich
- Departments of Vascular Surgery, University Hospital Innsbruck, Austria
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Abstract
Mycotic aneurysms of the innominate artery are infrequent lesions and, as such, represent challenging surgical problems. We describe herein a case of a ruptured mycotic innominate artery aneurysm, which developed after radical neck dissection and radiation therapy for tonsillar carcinoma. The aneurysm was successfully excluded from the systemic circulation with endoluminal placement of a covered stent, with efficacy confirmed by vascular imaging at 6 months follow-up. The patient suffered no permanent neurologic sequelae. Long-term follow-up and chronic antibiotic therapy will be necessary to avoid infection of the covered stent in this high-risk surgical patient.
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Affiliation(s)
- Ruth L Bush
- Cardiac and Vascular Surgery Center, Tallahassee Memorial Hospital, Tallahassee, Florida 32308, USA.
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37
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Tan TY, Lien LM, Schminke U, Tesh P, Reynolds PS, Tegeler CH. Hemodynamic effects of innominate artery occlusive disease on anterior cerebral artery. J Neuroimaging 2002; 12:59-62. [PMID: 11826600 DOI: 10.1111/j.1552-6569.2002.tb00091.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Stenoses of the innominate artery (IA) may affect flow conditions in the carotid arteries. However, alternating flow in ipsilateral anterior cerebral artery (ACA) due to IA stenosis is extremely rare. A 49-year-old woman who was evaluated for symptomatic cerebrovascular disease presented with right latent subclavian and right carotid system steal. Transcranial Doppler examination displayed systolic deceleration wave-forms in the right terminal internal carotid artery and alternating flow in the right ACA. Magnetic resonance angiography demonstrated tight stenosis of the right IA. For a thorough study of the hemodynamic effects of IA stenosis, a combination of duplex and transcranial Doppler examination is required.
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Affiliation(s)
- Teng-Yeow Tan
- Department of Neurology, Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien, Taiwan.
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Abstract
PURPOSE To describe endovascular repair of a large aneurysm of the innominate artery in a patient with episodes of transient cerebral ischemia. CASE REPORT A 44-year-old man with a history of transient hemiparesis and aphasia demonstrated a large mass in the upper right hemithorax on chest radiography. Systolic brachial pressure in the right arm was 100 mm Hg versus 130 mm Hg in the left. Imaging disclosed a large 12-mm-diameter aneurysm involving the brachiocephalic trunk 1 cm above its origin and the first portion of the right subclavian artery, which was occluded after the dilated segment. The aneurysm was treated with a tapered endograft made from polyester graft attached to a Palmaz stent inserted via a carotid artery arteriotomy. The distal end of the graft was anastomosed to the common carotid artery. Completion angiography showed exclusion of the aneurysm, which has been confirmed by imaging at 21 months. After 2 years, the patient is free from neurological symptoms and has a strong carotid pulse; no arm claudication developed. CONCLUSIONS Endovascular correction of innominate artery aneurysms is feasible whenever there is an adequate proximal neck for attachment. In these cases, thoracotomy may be avoided.
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Affiliation(s)
- P Puech-Leão
- Vascular Surgery Division, Faculty of Medicine, University of São Paulo, Brazil.
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Kieffer E, Chiche L, Koskas F, Bahnini A. Aneurysms of the innominate artery: surgical treatment of 27 patients. J Vasc Surg 2001; 34:222-8. [PMID: 11496272 DOI: 10.1067/mva.2001.115807] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE Aneurysms of the innominate artery (AIA) are widely considered to be a rare entity. We describe our experience with AIAs in the last three decades. METHODS From October 1973 to October 2000, we operated on 27 patients with an AIA. The underlying cause of aneurysm was Takayasu's disease in 7 patients, degenerative disease in 6 patients, syphilis in 5 patients, chronic dissection in 3 patients, trauma in 2 patients, infection in 2 patients, a postoperative complication in 1 patient, and Marfan syndrome in 1 patient. AIA was associated with an aortic aneurysm in 17 patients. Fourteen patients had no symptoms. The remaining patients had symptoms, with thromboembolic complications in 7 patients, pain without rupture in 3 patients, and a ruptured aneurysm in 3 patients. In two patients at high risk for surgery who had a small AIA with embolic complications, a cervical approach was used as a means of performing distal exclusion and crossover bypass. In the remaining 25 patients, a midline sternotomy was used. One patient with a ruptured AIA exsanguinated during sternotomy. Ten patients underwent a prosthetic replacement of the ascending aorta and/or aortic arch with a separate prosthetic branch to the innominate artery (IA). Thirteen patients underwent ascending aorta-to-IA prosthetic bypass in association with lateral suture (8 patients) or prosthetic patching (5 patients) of the aorta. One patient with an infected aneurysm was treated by means of resection of the aneurysm, proximal ligation of the IA, and transposition of the right into the left common carotid artery. Cardiopulmonary bypass with deep hypothermic circulatory arrest was used in 10 patients. RESULTS Three perioperative deaths occurred (2 of 4 in association with emergency treatment and 1 of 23 with elective treatment). Respiratory complications requiring prolonged artificial ventilation developed in five patients. Two patients had transient worsening of preoperative neurologic deficits. Late results, with a mean follow-up of 85 months, were good. CONCLUSION The etiology and presentation of AIAs are variable. Surgical management with current cardiovascular techniques achieves excellent results.
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Affiliation(s)
- E Kieffer
- Department of Vascular Surgery, Pitié-Salpêtrière University Hospital, Paris France.
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40
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Guibaud JP, Laborde MN, Dubrez J, Elia N, Remes J, Rosato F, Roques X, Baudet E. Surgical repair of an aneurysm of the innominate artery with fistulization into the trachea. Ann Vasc Surg 2001; 15:412-4. [PMID: 11414098 DOI: 10.1007/s100160010070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This report describes a 43-year-old patient presenting with an aneurysm located at the junction between the innominate artery and aorta, with spontaneous fistulization into the trachea. Emergency treatment of this unusually located lesion was undertaken to prevent intratracheal rupture. After ligation of the innominate artery, right common carotid artery, and right subclavian artery due to the risk of infection, the tracheal fistula was treated by direct closure and exclusion using an autologous pericardial flap. The procedure was performed under extracorporeal circulation and circulatory arrest with profound hypothermia.
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Affiliation(s)
- J P Guibaud
- Service de Chirurgie Cardiovasculaire and Service de Chirurgie Thoracique, Hôpital du Haut-Lévêque, CHU de Bordeaux, Bordeaux, France
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41
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Diseases of the Thoracic Aorta and Great Vessels. Surgery 2001. [DOI: 10.1007/978-3-642-57282-1_46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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42
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Surgical diseases of the great vessels. Curr Probl Surg 2000. [DOI: 10.1016/s0011-3840(00)80019-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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43
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Delap TG, Jones SE, Johnson DR. Aneurysm of an aberrant right subclavian artery presenting as dysphagia lusoria. Ann Otol Rhinol Laryngol 2000; 109:231-4. [PMID: 10685579 DOI: 10.1177/000348940010900221] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- T G Delap
- Department of Otolaryngology-Head and Neck Surgery, Northwick Park Hospital, London, England
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44
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Sakopoulos AG, Ballard JL, Gundry SR. Minimally invasive approach for aortic arch branch vessel reconstruction. J Vasc Surg 2000; 31:200-2. [PMID: 10642724 DOI: 10.1016/s0741-5214(00)70083-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Minimally invasive aortic arch branch vessel reconstruction was successfully accomplished in four patients over the past 3 years. There were no operative complications. Three patients had an uneventful hospital course, ranging from 3 to 5 days. The fourth patient with multiple medical problems and severe peripheral vascular disease had a prolonged hospital course for reasons unrelated to the surgical procedure. This minimally invasive surgical exposure can be used to effectively and safely repair innominate and left common carotid artery lesions.
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Affiliation(s)
- A G Sakopoulos
- Divisions of Cardiothoracic and Vascular Surgery, Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
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45
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Hadjipetrou P, Cox S, Piemonte T, Eisenhauer A. Percutaneous revascularization of atherosclerotic obstruction of aortic arch vessels. J Am Coll Cardiol 1999; 33:1238-45. [PMID: 10193722 DOI: 10.1016/s0735-1097(98)00690-1] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To compare stenting of aortic arch vessel obstruction with surgical therapy and to establish recommendations for treatment. BACKGROUND Though surgery has been considered to be the procedure of choice for subclavian and brachiocephalic obstruction, little work has been done to compare it with stenting. METHODS Eighteen patients with symptomatic aortic arch vessel stenosis or occlusion were treated with stenting, followed by periodic clinical follow-up and noninvasive arterial Doppler studies. Data were compared with the results as shown in a systematic review of a published series of surgery and stenting procedures which included comparison of technical success, complications, mortality and patency. RESULTS Primary success in our series was 100% with improvement in mean stenosis from 84+/-11% to 1+/-5% and mean arm systolic blood pressure difference from 44+/-16 mm Hg to 3+/-3 mm Hg. There were no major complications (death, stroke, TIA, stent thrombosis or myocardial infarction). At follow-up (mean 17 months), all patients were asymptomatic with 100% primary patency. Literature review demonstrates equivalent patency and complications in the other published series of stenting. In contrast, there was a similar patency but overall incidence of stroke of 3+/-4% and death of 2+/-2% in the published surgical series. CONCLUSIONS Subclavian or brachiocephalic artery obstruction can be effectively treated by primary stenting or surgery. Comparison of stenting and the surgical experience demonstrates equal effectiveness but fewer complications and suggests that stenting should be considered as first line therapy for subclavian or brachiocephalic obstruction.
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Affiliation(s)
- P Hadjipetrou
- Interventional Cardiovascular Medicine, Lahey Clinic, Medical Center, Burlington, Massachusetts 01805, USA
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46
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Takach TJ, Reul GJ, Cooley DA, Livesay JJ, Duncan JM, Ott DA, Hallman GL. Concomitant occlusive disease of the coronary arteries and great vessels. Ann Thorac Surg 1998; 65:79-84. [PMID: 9456099 DOI: 10.1016/s0003-4975(97)00863-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although an increasing number of elderly and high-risk patients, including those with generalized atherosclerosis, are undergoing coronary revascularization, few reports exist regarding the management of patients who have both occlusive disease of the great vessels and coronary artery disease. METHODS Between 1972 and 1996, 31 consecutive patients (mean age, 56.5 years; 74% men) with multivessel coronary artery disease and symptomatic occlusive disease of the great vessels (25 single-vessel, 80.6%; 6 multiple-vessel, 19.4%) had 40 great vessels reconstructed by transthoracic bypass (n = 17, 42.5%), transthoracic endarterectomy (n = 8, 20%), or extrathoracic bypass (n = 15, 37.5%). All patients had simultaneous coronary artery bypass grafting (mean, 2.6 grafts per patient), and 8 patients had 10 distal carotid bifurcation endarterectomies (6 staged, 4 simultaneous). RESULTS The early primary patency rate was 100%, and symptoms resolved completely in all 31 patients. There was 1 in-hospital death (3.2%) in a patient who had a respiratory arrest 11 days after operation. Perioperative morbidity included two myocardial infarctions (6.5%) and one opposite-hemisphere, embolic stroke (3.2%). Long-term follow-up of the 30 survivors (167.4 patient-years; mean, 5.6 years per patient) documented 5- and 10-year actuarial survival rates of 88.6% and 60.4%, respectively, with a 100% late brachiocephalic primary patency rate. Ten-year actuarial rates of freedom from the following events were as follows: death, 60.4%; myocardial infarction, 82.5%; stroke, 90.9%; percutaneous transluminal coronary angioplasty or redo coronary artery bypass grafting, 95.2%; and vascular operation or amputation, 78.4%. CONCLUSIONS Depending on the anatomic distribution of the disease, an integrated approach to great vessel reconstruction that incorporated transthoracic and extrathoracic approaches and techniques of endarterectomy and bypass resulted in few adverse outcomes and excellent long-term patency. Simultaneous revascularization of the great vessels and coronary arteries can produce immediate and long-term, symptom-free outcome with acceptably low operative risk.
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Affiliation(s)
- T J Takach
- Department of Cardiovascular Surgery, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston 77225-0345, USA
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48
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Prétre R, Chilcott M, Mürith N, Panos A. Blunt injury to the supra-aortic arteries. Br J Surg 1997. [DOI: 10.1046/j.1365-2168.1997.02756.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
PURPOSE The purpose of this study was to evaluate the safety and effectiveness of Palmaz stents as a less morbid alternative to traditional surgery for focal aortic arch branch lesions. METHODS Twenty-two patients with symptoms and a mean age of 61.3 years were treated from July 1991 to May 1995 with 26 stents at the following locations: 8 innominate artery, 5 left common carotid artery, 1 right common carotid artery, and 12 left subclavian. Procedures were carried out in an operating room with patients receiving either local anesthetic in 12 cases or general anesthetic in 10. Surgical exposure of either the cervical common carotid or brachial artery allowed precautionary distal clamping before retrograde stent deployment to prevent atheroembolization. RESULTS Initial success was possible in 92.3% (24 of 26) of cases. There were no strokes or deaths. During a mean follow-up period of 27 months, 22 of 26 (85%) vessels have remained patent and the patients symptom free. CONCLUSION Focal aortic branch lesions can be effectively and safely treated with Palmaz stents.
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Affiliation(s)
- L A Queral
- The Maryland Vascular Institute, Baltimore, 21218-2895, USA
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50
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Banks E, Chun J, Weaver FA. Chronic innominate artery dissection after blunt thoracic trauma: case report. THE JOURNAL OF TRAUMA 1995; 38:975-8. [PMID: 7602651 DOI: 10.1097/00005373-199506000-00032] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Blunt innominate chest trauma is relatively rare, with only 70 cases being reported in the surgical literature since 1960. This report describes a 20-year-old male who sustained a blunt chest injury that resulted in an innominate artery dissection. The patient's clinical course and management are discussed, as well as a review of the surgical literature.
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Affiliation(s)
- E Banks
- Department of Surgery, Division of Vascular Surgery, University of Southern California School of Medicine, Los Angeles 90033-4612, USA
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