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Zur G, Fageeh A, Diouf A, Charette S, Charbonneau B, Sellami L, Dos Santos M, Lesiuk H, Drake B, Fahed R. Embolization of a pseudoaneurysm of the innominate artery with a Woven EndoBridge (WEB) device. Interv Neuroradiol 2024:15910199241240504. [PMID: 38529582 DOI: 10.1177/15910199241240504] [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: 03/27/2024] Open
Abstract
The Woven EndoBridge (WEB) is an intra-aneurysmal flow disruptor designed for the treatment of broad-based arterial aneurysms with a high safety and effectiveness profile.1, 2 It does not require concomitant antiplatelet therapy compared to other devices such as flow diverters or intracranial stents. Innominate artery pseudoaneurysms are a rare consequence of blunt traumatic injury, infection, or atherosclerotic disease.3, 4 We describe the case of an innominate artery pseudoaneurysm successfully treated with a WEB SL device instead of stenting, therefore alleviating the need for dual antiplatelet therapy. The treatment was successful and uneventful and postprocedural computed tomography angiography confirmed the complete occlusion of the pseudoaneurysm.
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Affiliation(s)
- Gil Zur
- Interventional Neuroradiology Section, The Ottawa Hospital, Ottawa, Canada
| | - Areej Fageeh
- Interventional Neuroradiology Section, The Ottawa Hospital, Ottawa, Canada
| | - Ange Diouf
- Interventional Neuroradiology Section, The Ottawa Hospital, Ottawa, Canada
| | - Stacey Charette
- Interventional Neuroradiology Section, The Ottawa Hospital, Ottawa, Canada
| | | | | | - Marlise Dos Santos
- Interventional Neuroradiology Section, The Ottawa Hospital, Ottawa, Canada
- Divison of Neurosurgery, Department of Medicine, The Ottawa Hospital, Ottawa, Canada
| | - Howard Lesiuk
- Interventional Neuroradiology Section, The Ottawa Hospital, Ottawa, Canada
- Divison of Neurosurgery, Department of Medicine, The Ottawa Hospital, Ottawa, Canada
| | - Brian Drake
- Interventional Neuroradiology Section, The Ottawa Hospital, Ottawa, Canada
- Divison of Neurosurgery, Department of Medicine, The Ottawa Hospital, Ottawa, Canada
| | - Robert Fahed
- Interventional Neuroradiology Section, The Ottawa Hospital, Ottawa, Canada
- Divison of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Canada
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2
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Mozafar M, Najari D, Refaei M, Sheikhzadeh M, Mirhosseini MM. Innominate artery aneurysm in behcet disease; report of one case. Int J Surg Case Rep 2024; 116:109314. [PMID: 38325109 PMCID: PMC10859271 DOI: 10.1016/j.ijscr.2024.109314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION Behçet disease (BD) is a multisystemic recurrent inflammatory disorder that was originally described as a triad of oral and genital ulcerations with uveitis (Behcet, 1937 [1]). Arterial involvement is the most common cause of mortality in patients with BD. Aneurysms are common among the arterial lesions and affect various arteries, but mostly the abdominal aorta. Vascular lesions are encountered in 7 %-29 % of patients, gravely affecting the course of the disease. Extracranial carotid aneurysms due to Behçet's disease are extremely rare (Bouarhroum et al. (2006) [2]). CASE PRESENTATION Herein, we present a 19 year old man presented with hoarsness due to pressure effect to our outpatient clinic. CLINICAL DISCUSSION Due to findings in the computed angiography, he underwent surgery twice.A 100*8 COVERA-covered stent was deployed at the bifurcation of the brachiocephalic artery. Then a 40*13.5 FLUENCY stent with a 2 cm overlap from the previous stent was deployed. CONCLUSION Further investigations regarding endovascular approach for this rare disease is recommended.
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Affiliation(s)
- Mohammad Mozafar
- Division of Vascular and Endovascular Surgery, Department of Surgery, Shohada-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Dorsa Najari
- Division of Vascular and Endovascular Surgery, Department of Surgery, Shohada-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Meisam Refaei
- Division of Vascular and Endovascular Surgery, Department of Surgery, Shohada-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Sheikhzadeh
- Division of Vascular and Endovascular Surgery, Department of Surgery, Shohada-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Moein Mirhosseini
- Division of Vascular and Endovascular Surgery, Department of Surgery, Shohada-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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3
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Inam H, Ahad A, Sundardas R, Shaikh FA, Sharfuddin S, Siddiqui NA. Autologous vein graft repair of mycotic innominate artery aneurysm: A case report. Int J Surg Case Rep 2023; 103:107902. [PMID: 36736228 PMCID: PMC9925949 DOI: 10.1016/j.ijscr.2023.107902] [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: 11/06/2022] [Revised: 01/07/2023] [Accepted: 01/11/2023] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Innominate artery aneurysm (IAA) is an extremely rare fatal condition with an overall prevalence of less than 3 % of all supra-aortic artery aneurysms. These infrequent lesions usually present as an emergency and require challenging surgical procedures. CASE PRESENTATION We report an interesting case of mycotic IAA in a 25 years old male patient. He was a known intravenous drug abuser having mycotic aneurysm arising from brachiocephalic artery with eccentric thrombus causing adjacent mass effect over the trachea. He underwent successful emergent surgical management of aneurysm with autologous vein graft using superficial femoral vein. Unfortunately, he died due to massive upper gastrointestinal bleeding leading to multi-organ failure after a prolonged post-operative course. CLINICAL DISCUSSION Mycotic aneurysms of the IA are extremely rare with an overall incidence of 1-2.7 % cases of all IAA. Presentation of the IAA can be quite variable from asymptomatic to symptoms exhibiting mass effect over surrounding structures. Rupture of IAA can be fatal and can occur if not treated promptly. There are no current recommendations or guidelines for treatment and interventions in IAA. Surgical management involves complete excision of the aneurysm and then revascularization. CONCLUSION Infected Innominate artery aneurysm is a rare surgical entity requiring early diagnosis, detailed investigation and prompt surgical management involving multidisciplinary team approach. Our case describes a relatively innovative approach to this scarce condition.
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Affiliation(s)
- Hina Inam
- Section of Cardiothoracic Surgery, Aga Khan University Hospital Karachi, Pakistan
| | - Abdul Ahad
- Resident Cardiothoracic Surgery, Section of Cardiothoracic Surgery, Aga Khan University Hospital Karachi, Pakistan
| | | | - Fareed Ahmed Shaikh
- Vascular Surgery, Link Building, Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, Pakistan.
| | | | - Nadeem Ahmed Siddiqui
- Vascular Surgery, Link Building, Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, Pakistan
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4
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Johari HG, Moein SA, Shenavande S, Amirian A, Nabavizadeh SS. Ruptured innominate artery pseudoaneurysm presenting as hoarseness in Behçet’s syndrome: a case report. J Med Case Rep 2022; 16:439. [DOI: 10.1186/s13256-022-03662-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 10/29/2022] [Indexed: 11/25/2022] Open
Abstract
Abstract
Background
Vascular involvement is an infrequent clinical manifestation of Behçet’s syndrome. Owing to the rarity of arterial involvement in Behçet’s syndrome, there is limited experience in managing this phenomenon.
Case presentation
Here, we report a 28-year-old Iranian man with a Behçet’s syndrome background, who presented with shoulder pain and hoarseness. Chest computed tomography angiography was conducted with a suspicion of a vascular pathology causing pressure on the recurrent laryngeal nerves. The patient was diagnosed with a ruptured innominate artery pseudoaneurysm. An innominate artery to the right common carotid artery bypass was performed, and the pseudoaneurysm was excised and replaced with an expandable polytetrafluoroethylene graft. Eventually, the patient was discharged after an uneventful hospital course.
Conclusion
It appears that we are still a long way from finding the optimal treatment for Behçet’s syndrome vascular involvement, and a combination of surgical and medicinal treatments is required.
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5
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O'Dwyer M, Togher Z, Lim ST, Ryan M, Garcia-Gallardo A, O'Connell K, Tolan MJ. Brachiocephalic artery aneurysm plaque rupture, stroke & repair. Radiol Case Rep 2022; 17:1784-1788. [PMID: 35369543 PMCID: PMC8965028 DOI: 10.1016/j.radcr.2022.02.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/19/2022] [Indexed: 10/27/2022] Open
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6
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Wannatoop T, Slisatkorn W. Endovascular treatment of concomitant innominate and subclavian artery injury with pseudoaneurysms from a gunshot wound in a polytrauma patient. TRAUMA-ENGLAND 2021. [DOI: 10.1177/14604086211016705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Injury of the innominate artery (IA) is associated with high mortality and morbidity, such as a major neurologic event. The aim of this case report was to describe an example of prioritization in polytrauma management by applying endovascular intervention in a difficult case with impending uncal herniation, extensive cerebral infarction, and large pseudoaneurysm from concomitant innominate and right subclavian artery injuries. Case Report A 34-year-old woman sustained a gunshot wound to her upper chest that lodged in the anterior triangle of her neck and presented with tension pneumothorax and cardiac arrest, which was successfully resuscitated. Subsequently she developed drowsiness and left hemiparesis, and computerized tomography demonstrated a large right cerebral hemisphere and left cerebellar region infarction with impending uncal herniation and pseudoaneurysms from the IA and proximal right subclavian artery. After emergency craniectomy to avert herniation, endovascular treatment was performed to facilitate vessel repair due to anatomical difficulty and the patient’s unstable condition. She was discharged home 3 weeks after operation, and 2 months postoperatively, she was neurologically intact with no evidence of endoleakage or pseudoaneurysm. Conclusion In such a complex polytrauma case, correct prioritization of interventions is crucial to obtaining the best outcomes, and the Endovascular Resuscitation and Trauma Management protocol can be applied as an alternative treatment protocol with good results.
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Affiliation(s)
- Tongporn Wannatoop
- Department of Surgery, Division of Trauma Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Worawong Slisatkorn
- Department of Surgery, Division of Cardio-Thoracic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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7
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Bougrine R, Aissaoui H, Elouafi N, Alloubi I, Ismaili N. The Surgical Management of a Giant Innominate Artery Aneurysm in a Patient With Coronary Disease: A Case Report. Cureus 2021; 13:e13038. [PMID: 33665059 PMCID: PMC7924907 DOI: 10.7759/cureus.13038] [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] [Indexed: 11/06/2022] Open
Abstract
The innominate artery aneurysm (IAA) accounts for a small percentage of all peripheral aneurysms. However, its clinical outcomes are potentially devastating, especially when it is associated with coronary disease, due to the high risk of spontaneous rupture and thromboembolic complications. Surgical repair is always recommended in such cases. The treatment of such a condition presents a surgical challenge with high morbidity and mortality rates. In this report, we discuss the case of a 56-year-old male who presented with a right cervical mass secondary to a large IAA with underlying coronary artery disease. The patient underwent a simultaneous operation for IAA and coronary bypass grafting.
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Affiliation(s)
- Ramia Bougrine
- Department of Cardiology, Mohammed I University/Mohammed VI University Hospital/Epidemiological Laboratory of Clinical Research and Public Health, Oujda, MAR
| | - Hanane Aissaoui
- Department of Cardiology, Mohammed I University/Mohammed VI University Hospital/Epidemiological Laboratory of Clinical Research and Public Health, Oujda, MAR
| | - Noha Elouafi
- Department of Cardiology, Mohammed I University/Mohammed VI University Hospital/Epidemiological Laboratory of Clinical Research and Public Health, Oujda, MAR
| | - Ihsane Alloubi
- Department of Cardiovascular Surgery, Mohammed I University/Mohammed VI University Hospital/Epidemiological Laboratory of Clinical Research and Public Health, Oujda, MAR
| | - Nabila Ismaili
- Department of Cardiology, Mohammed I University/Mohammed VI University Hospital/Epidemiological Laboratory of Clinical Research and Public Health, Oujda, MAR
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8
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Mukherjee D, Lewis E, Ryan L. Endovascular Repair of Symptomatic Right Subclavian and Innominate Artery Aneurysms Arising From a "Bovine Arch" in a Patient With a "Hostile" Chest. Vasc Endovascular Surg 2020; 55:290-294. [PMID: 33054602 DOI: 10.1177/1538574420967545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Symptomatic aneurysms of the innominate and subclavian arteries are rare and pose unique challenges for endovascular repair particularly in a patient with a "bovine" arch. Previous publications have described back table modifications of standard iliac endografts to conform to the innominate artery for exclusion of the lesion. Others have proposed extra-anatomic bypass or carotid-subclavian transposition with occlusion of the innominate artery. We were unable to find a report of repair when aneurysms of the innominate and subclavian arteries were in continuity. We present such a case of endovascular repair using commercially available endografts without compromise of the left common carotid artery origin as this patient had a "bovine" arch. Surgeons will benefit from adding this endovascular option to their "tool box" when confronted with such a challenging clinical scenario.
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Affiliation(s)
| | | | - Liam Ryan
- Inova Heart and Vascular Institute, Falls Church, VA, USA
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9
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Wang WD, Sun R, Zhou MX, Liu XR, Zheng YH, Chen YX. A complicated case of innominate and right common arterial aneurysms due to Takayasu’s arteritis. World J Clin Cases 2019; 7:1671-1676. [PMID: 31367626 PMCID: PMC6658365 DOI: 10.12998/wjcc.v7.i13.1671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/15/2019] [Accepted: 05/01/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Innominate artery aneurysms (IAAs) are relatively rare. Endovascular therapy has been an alternative to open surgery in some IAA cases, but open repair is still necessary in complicated cases.
CASE SUMMARY We report a 35-year-old female who suffered from Takayasu’s arteritis. The patient did not get regular treatment, and IAA and right common carotid artery aneurysm developed, which complicated with occlusion of the left carotid artery, subclavian artery, and the initial part of the left vertebral artery. The patient also had moderate aortic valve insufficiency. With inflammation being controlled well, the patient received the surgery for arterial aneurysms of innominate and right common carotid arteries and aortic valve insufficiency. The shunts for cerebral blood supply were designed to protect the brain and the surgery was conducted successfully under extracorporeal circulation.
CONCLUSION The case illustrates that open surgery may be appropriate for some complicated IAAs, and brain protection is important.
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Affiliation(s)
- Wen-Da Wang
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Rui Sun
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Meng-Xin Zhou
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xing-Rong Liu
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yue-Hong Zheng
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yue-Xin Chen
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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10
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Lazopoulos G, Kalogerakos PD, Pavlopoulos D, Chaniotaki F, Dermitzaki D, Kokotsakis J. Debranching-first and proximal arch replacement for an innominate artery aneurysm: a case study. Perfusion 2019; 35:9-12. [PMID: 31203765 DOI: 10.1177/0267659119856240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aneurysms of the innominate artery represent a rare form of aneurysmal disease. Management in an early elective basis is recommended due to the risk of stroke and rupture. Treatment options include open surgery, which is the gold standard, and endovascular repair. We describe the debranching-first technique and proximal arch replacement for a huge innominate artery aneurysm and discuss the surgical strategy for cannulation, perfusion and organ protection.
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Affiliation(s)
- George Lazopoulos
- Division of Cardiac Surgery, University General Hospital of Heraklion, Crete, Greece
| | | | - Dionysios Pavlopoulos
- Division of Cardiac Surgery, University General Hospital of Heraklion, Crete, Greece
| | - Foteini Chaniotaki
- Department of Anesthesiology, University General Hospital of Heraklion, Crete, Greece
| | - Despoina Dermitzaki
- Department of Anesthesiology, University General Hospital of Heraklion, Crete, Greece
| | - John Kokotsakis
- Division of Cardiac Surgery, University General Hospital of Heraklion, Crete, Greece
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11
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Fernandez Prendes C, Del Castro Madrazo JA, Padron Encalada CE, Dominguez MR, Camblor Santervas LA, Perez MA. Hybrid Repair of an Innominate Artery Mycotic Aneurysm with an "On-The-Table" Customized Endograft. Ann Vasc Surg 2019; 59:311.e5-311.e9. [PMID: 30802585 DOI: 10.1016/j.avsg.2018.12.097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 12/13/2018] [Accepted: 12/20/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The objective of this report is to present a challenging case of a mycotic aneurysm of the innominate artery (IA) in a patient with a bovine aortic arch. MATERIALS AND METHODS An 85-year-old woman presented with intermittent fever and positive blood cultures for Staphylococcus aureus. An echocardiogram and a positron emission tomography-computed tomography were performed, showing a hypermetabolic dilation of the IA compatible with a mycotic aneurysm with a type one bovine aortic arch. Conventional open arch repair and total endovascular repair with a custom-made aortic endograft were rejected given the elderly age and need for urgent repair. Treatment was achieved with a hybrid procedure, including a left carotid transposition and exclusion of the aneurysm with a modified Endurant II® iliac limb (two stents were cut off and it was resheathed in an inverted fashion) released through a prosthetic graft sutured onto the right axillary artery, followed by coil embolization of the sac. One year after the repair, the patient is well with complete exclusion of the aneurysm. CONCLUSIONS Under the need for urgent repair, "on-the-table" modification of standard endograft components can be an effective solution for aneurysm exclusion when off-the-shelf endovascular stent grafts do not meet the anatomical requirements.
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Affiliation(s)
- Carlota Fernandez Prendes
- Department of Vascular Surgery, Hospital Universitario Central de Asturias (H.U.C.A), Oviedo, Spain.
| | | | | | | | | | - Manuel Alonso Perez
- Department of Vascular Surgery, Hospital Universitario Central de Asturias (H.U.C.A), Oviedo, Spain
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12
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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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13
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Urbanski PP, Irimie V, Lenos A, Bougioukakis P, Atieh A, Lehmkuhl L. Innominate artery pathology in the setting of aortic arch surgery: incidences, surgical considerations and operative outcomes. Eur J Cardiothorac Surg 2018; 55:351-357. [DOI: 10.1093/ejcts/ezy267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 06/26/2018] [Indexed: 12/15/2022] Open
Affiliation(s)
- Paul P Urbanski
- Department of Cardiovascular Surgery, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany
| | - Vadim Irimie
- Department of Cardiovascular Surgery, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany
| | - Aristidis Lenos
- Department of Cardiovascular Surgery, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany
| | - Petros Bougioukakis
- Department of Cardiovascular Surgery, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany
| | - Alaa Atieh
- Department of Cardiovascular Surgery, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany
| | - Lukas Lehmkuhl
- Department of Radiology, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany
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14
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Sugisawa R, Sano M, Yamamoto N, Inuzuka K, Tanaka H, Saito T, Katahashi K, Yata T, Kayama T, Yamanaka Y, Takeuchi H, Unno N. Axillo-Axillary Artery Bypass With Coil Embolization of the Innominate Artery for a Traumatic Innominate Artery Aneurysm: A Case Report. Vasc Endovascular Surg 2018; 52:573-578. [PMID: 29807496 DOI: 10.1177/1538574418775183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Innominate artery aneurysm (IAA) is a rare cervical artery aneurysm. Although atherosclerosis is its most common cause, IAAs due to cervical injury are often reported. Operative indications for IAAs include rupture or symptomatic aneurysm, saccular aneurysm, aneurysm with a diameter of 3 cm or greater, and aneurysmal change of the origin of the innominate artery. Although the ligature of the innominate artery or open surgical repair is well described, the usefulness of endovascular repair has also recently been reported. Herein, we report a case of traumatic IAA with infection in the cervical region after tracheostomy. CASE PRESENTATION A 40-year-old man with cholecystolithiasis planned to undergo laparoscopic cholecystectomy at another hospital. Urgent tracheostomy was performed because of laryngeal edema at the induction of general anesthesia. Enhanced computed tomography angiography 1 week after the tracheostomy revealed a saccular IAA. The patient was deemed to be at high risk for aneurysm rupture and was referred to our hospital. Preoperative Matas test, Allcock test, and innominate arterial stump pressure measurement were performed to assess the cerebral blood flow and ischemic tolerance of the brain. These examinations showed the patency of the circle of Willis. An axillo-axillary artery bypass with coil embolization of the innominate artery was performed to avoid postoperative vascular graft infection. No postoperative complications such as infection or cerebral infarction occurred. Magnetic resonance imaging angiography performed 6 months after surgical treatment showed that the aneurysm had disappeared, and patency of the bypass graft was present. There were no postoperative complications, such as neurological deficits or graft infection, at more than 5 years after surgery. CONCLUSIONS We report a successfully treated case of IAA after tracheostomy. Axillo-axillary artery bypass with coil embolization of the innominate artery is an effective treatment of IAA with cervical infection.
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Affiliation(s)
- Ryota Sugisawa
- 1 Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.,2 Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Masaki Sano
- 1 Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.,2 Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Naoto Yamamoto
- 3 Division of Vascular Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan
| | - Kazunori Inuzuka
- 1 Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.,2 Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Hiroki Tanaka
- 1 Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.,2 Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Takaaki Saito
- 1 Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.,2 Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Kazuto Katahashi
- 1 Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.,2 Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Tatsuro Yata
- 1 Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.,2 Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Takafumi Kayama
- 1 Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.,2 Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yuta Yamanaka
- 1 Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.,2 Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Hiroya Takeuchi
- 2 Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Naoki Unno
- 1 Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.,3 Division of Vascular Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan
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15
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Abstract
We herein describe our
*These authors contributed equally to this work. experience with a congenital innominate artery aneurysm (IAA) that was managed with a simple surgical procedure. A 44-year-old woman was admitted for chest distress. Computed tomography angiography showed a 3.6-cm IAA arising from the aortic arch and compressing the trachea. A median sternotomy was performed with the patient under general anesthesia, and the IAA was found to involve the origin of the innominate artery and the bifurcation of the right subclavian artery and common carotid artery; however, the aorta was intact. An 8-mm Dacron graft was anastomosed to the ascending aorta and distal end of the IAA without cardiopulmonary bypass. The postoperative course was uneventful, and repeat computed tomography angiography revealed no evidence of recurrence 6 months postoperatively. We also herein present a literature review of this rare clinical condition.
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Affiliation(s)
- Xiao-Long Wang
- 1 Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,2 Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,3 Beijing Lab for Cardiovascular Precision Medicine, Beijing, China.,4 Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing, China.,5 Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Xin-Liang Guan
- 1 Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,2 Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,3 Beijing Lab for Cardiovascular Precision Medicine, Beijing, China.,4 Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing, China.,5 Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Wen-Jian Jiang
- 1 Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,2 Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,3 Beijing Lab for Cardiovascular Precision Medicine, Beijing, China.,4 Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing, China.,5 Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Ou Liu
- 1 Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,2 Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,3 Beijing Lab for Cardiovascular Precision Medicine, Beijing, China.,4 Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing, China.,5 Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Hong-Jia Zhang
- 1 Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,2 Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,3 Beijing Lab for Cardiovascular Precision Medicine, Beijing, China.,4 Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing, China.,5 Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
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16
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Kalisz K, Rajiah P. Radiological features of uncommon aneurysms of the cardiovascular system. World J Radiol 2016; 8:434-448. [PMID: 27247710 PMCID: PMC4882401 DOI: 10.4329/wjr.v8.i5.434] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 02/02/2016] [Accepted: 03/09/2016] [Indexed: 02/06/2023] Open
Abstract
Although aortic aneurysms are the most common type encountered clinically, they do not span the entire spectrum of possible aneurysms of the cardiovascular system. As cross sectional imaging techniques with cardiac computed tomography and cardiac magnetic resonance imaging continue to improve and becomes more commonplace, once rare cardiovascular aneurysms are being encountered at higher rates. In this review, a series of uncommon, yet clinically important, cardiovascular aneurysms will be presented with review of epidemiology, clinical presentation and complications, imaging features and relevant differential diagnoses, and aneurysm management.
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17
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Tamura K, Kihara K, Chikazawa G, Sakaguchi T, Yoshitaka H. A Case of Dissection and Rupture of the Innominate Artery in Acute Type A Aortic Dissection. Ann Vasc Dis 2016; 9:117-9. [PMID: 27375807 DOI: 10.3400/avd.cr.15-00110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 04/05/2016] [Indexed: 12/18/2022] Open
Abstract
We report the case of a 59-year-old male presenting with dissection and rupture of the innominate artery with acute type A aortic dissection. We performed total arch replacement via median sternotomy with extension into the right side of the neck. The innominate artery was reconstructed just proximal to the bifurcation of the right subclavian artery and common carotid artery using the 1st limb of a 4-branched graft. This case illustrates an unusual aspect of an isolated innominate artery rupture in the absence of aortic rupture in acute type A aortic dissection.
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Affiliation(s)
- Kentaro Tamura
- Division of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Okayama, Japan
| | - Kazuki Kihara
- Division of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Okayama, Japan
| | - Genta Chikazawa
- Division of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Okayama, Japan
| | - Taichi Sakaguchi
- Division of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Okayama, Japan
| | - Hidenori Yoshitaka
- Division of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Okayama, Japan
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18
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Boutayeb A, Porcu P, Pirvu A, Chavanon O. Post-traumatic Injury of the Brachiocephalic Artery: On-pump Beating Heart Repair. Heart Lung Circ 2014; 23:e226-8. [DOI: 10.1016/j.hlc.2014.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 05/01/2014] [Accepted: 05/07/2014] [Indexed: 12/28/2022]
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