A blunt traumatic giant pseudoaneurysm of the brachiocephalic artery: A case report from Somalia

INTRODUCTION

Pseudoaneurysm of the brachiocephalic artery is a rare condition that can occur as a result of various causes, including trauma, iatrogenic injury, and infection. The clinical presentation of brachiocephalic artery pseudoaneurysms can vary depending on the size and location of the pseudoaneurysm. The treatment options for innominate artery pseudoaneurysms include both surgical and endovascular approaches. Our goal of the study is to increase awareness and early detection of blunt injuries in the chest, clavicle, or sternoclavicular joint that may cause a vascular injury.

CASE PRESENTATION

We present here A 24-year-old male came to present with an acute onset of dyspnea, stridor (an abnormal, high-pitched respiratory sound produced by irregular airflow in a narrowed airway), a worsening cough, and chest pain that had been worsening over several months. His medical history was significant for blunt chest trauma secondary to a bicycle fall 3 months earlier.

DISCUSSION

A traumatic giant pseudoaneurysm of the innominate artery is a rare but potentially life-threatening condition. Treatment options for brachiocephalic artery pseudoaneurysm include both endovascular and surgical approaches. This case report contributes to the current literature when any patient has a blunt injury in the chest, clavicle, or sternoclavicular joint and is highly suspect of a vascular injury. To increase awareness, we first need to exclude if there is any vascular injury, which helps to detect it early and intervene.

CONCLUSION

Brachiocephalic artery traumatic large pseudoaneurysm is an uncommon but potentially fatal disorder that can arise from a number of different sources. Achieving favorable results requires prompt diagnosis and proper care, which may include open surgical repair and endovascular procedures. To better comprehend the condition and optimize its management approaches, more investigation and case studies are required.

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.

Blunt Injury of the Innominate Artery: What Surprises to Expect? A Case Report

Injuries of the supra-aortic trunk after blunt chest trauma are rare. This is a case report of a blunt traumatic lesion of the innominate artery (IA) origin that exhibited aortic arch involvement with a focus on imaging and treatment. A 41-year-old fisherman presented an IA injury secondary to a high-impact blunt chest trauma. Upon physical examination, vital signs were stable and upper extremity pulses were present. In addition to several bone fractures (costal ribs, clavicle, scapula, temporal, maxillary, and sphenoid), computed tomography angiography revealed dissection/pseudoaneurysm of the IA sparing the bifurcation. The patient underwent emergent angiography, which confirmed that the IA dissection was not ruptured, but it was unclear whether there was a pseudoaneurysm at the origin of the IA or aortic arch involvement. The patient was considered for open surgery. An ascending aorta-to-IA bypass was achieved by the off-pump beating heart approach. The IA stump was carefully observed, but oversewing was not possible due to the extension of the intimal-medial lesions into the artic arch. An on-pump intervention was then required for aortic angioplasty with a pericardial patch that was reinforced by Gel Seal. The postoperative course was uneventful. The patient was discharged without any complications. Conventional surgery provides good results and should remain in the armamentarium for the treatment of traumatic lesions at the IA origin, particularly if aortic arch involvement cannot be ruled out, to ensure a truly patient-tailored approach.

Open Treatment of Blunt Injuries of Supra-Aortic Branches: Case Series

BACKGROUND

Blunt injuries of the supra-aortic branches are rare entity, and majority of patients die before arrival at the hospital. Those who arrive alive require complex and fast procedure that requires sternotomy. We report 3 successfully managed cases.

CASE REPORTS

We report 3 patients with injury of supra-aortic branches. One was treated urgently due to longitudinal rupture on the posterior wall of innominate artery after car accident, and another 2 had chronic false aneurysm located at the very orifice of the right subclavian and left common carotid artery. In first and second patient bypass grafting with a hand-made, Y-shaped, 8-mm Dacron graft from the ascending aorta to the right common carotid and proximal right subclavian artery were performed, whereas in last 1 bypass grafting from the ascending aorta to the cervical part of the left common carotid artery was performed. In our facility, there were no possibilities for any endovascular treatment.

CONCLUSIONS

When endovascular technology is not available, open surgical repair of blunt injuries of supra-aortic vessels can be performed without complications. No matter to that, endovascular and hybrid procedures should be considered whenever possible.