Innominate artery post-traumatic pseudoaneurysm presenting with Horner's syndrome

Isolated innominate artery trauma after blunt thoracic contusion is rare and occurs mostly at its origin. We report a case of a post-traumatic distal innominate artery pseudoaneurysm presenting with Horner's syndrome treated by conventional surgical approach.

Covered Endovascular Repair of Innominate Artery Bifurcation After Thoracic Blunt Trauma

Innominate artery (IA) injury is a rare entity with most patients dying before reaching the hospital. While open surgery remains the standard treatment, the endovascular approach is attractive as it may reduce perioperative morbidity and mortality. We report a case of IA blunt injury extending to the subclavian artery with pseudoaneurysm formation successfully treated with covered stenting of IA and its bifurcation. A 49-year-old male was admitted after suffering multiple trauma due to a high energy impact motorcycle crash. In the emergency room, the patient was hypotensive with a Glasgow coma score of 15. On physical examination, he had right peri-orbital ecchymosis, left otorrhagia and an open patella fracture. The computed tomographic angiography (CTA) revealed enlargement of the mediastinum and a 29 mm pseudoaneurysm involving the right brachiocephalic trunk and its bifurcation. Under general anesthesia, a covered balloon-expandable stent (CBES) was then placed in the IA followed by kissing stent of its bifurcation with an additional 2 covered balloon-expandable stents. Final subtraction angiography demonstrated complete pseudoaneurysm exclusion and stent patency without additional complications. No neurologic deficits or other intervention-related complications were found in the postoperative period. At 10 months follow-up, the patient remained asymptomatic and with palpable distal pulses. Endovascular management of IA injury may provide a good alternative to open surgery with low perioperative morbidity and mortality.

A Complicated Case of Innominate Artery Avulsion and Subsequent Aorto-subclavian Graft Occlusion

A 41-year-old female presented with complaints of right arm claudication, weakness, and pain associated with serous drainage from a previous incision site to the right anterior chest. At age 16, this patient was involved in a motor vehicle accident, which resulted in a right innominate artery and brachiocephalic vein avulsion. The two vessels were immediately ligated and oversewn. The perfusion to her right arm was supplied by cerebral collateral circulation down the right vertebral to the right subclavian artery.