Endovascular Repair of an Innominate Artery False Aneurysm Following Blunt Trauma

Covered stent implantation for anastomotic pseudoaneurysm of innominate artery post total aortic arch replacement

A 59-year-old man presented with back pain that lasted 2 h. Computed tomography revealed acute type A dissection. Emergent total aortic arch replacement was performed on the same day. In 2 weeks later, CT angiography (CTA) showed the aneurysm of his innominate artery. Endovascular repair using covered stent by transbrachial artery approach was successfully performed. CTA at 8 months showed that pseudoaneurysm was excluded. The patient had no symptoms and no other complications were seen. Percutaneous endovascular therapy can be applied for high-risk patient of suprathoracic open surgery.

Overview of Great Vessel Trauma

Traumatic injury to the aorta and the brachiocephalic branches are potentially lethal injuries. Specialized preoperative imaging and medical management can lead to better outcomes in this group of patients. In addition, improved surgical techniques for spinal cord protection have led to decreased morbidity in surgical candidates. TEVAR remains a promising technique; however, long-term data currently are not available.

Treatment of nonaortic aneurysms in the endograft era: aneurysms of the innominate and subclavian arteries

Although open aneurysm repair remains the standard of care, the advent of endoluminal techniques and stent grafts has significant potential to improve treatment of aneurysms of the innominate and subclavian arteries. Regardless of the modality chosen, therapy must be individualized and treatments tailored on the basis of anatomic and etiologic considerations. Occasionally, definitive treatment of an aneurysm with endoluminal stent-graft placement is possible for focal aneurysms or pseudoaneurysms of the innominate or subclavian arteries. In other situations, endoluminal grafting may be combined with open repair to allow for the benefits of both techniques. Ultimately long-term follow-up data are necessary to determine whether the durability of the endoluminal approach warrants more widespread use.

Review of branch aortic injuries in blunt chest trauma

OBJECTIVES

To review the incidence, mechanisms of injury, diagnosis and treatment of injuries to the major branches of the thoracic aorta within the thoracic cavity following blunt trauma.

METHODS

Medline, Embase and Cochrane were searched using appropriate key word and MeSH headings. Full text articles were retrieved where there was any information relating to the mechanism of injury, incidence of injury, diagnosis, treatment or outcome in patients with injuries to the brachiocephalic, subclavian or carotid arteries within the thoracic cavity following blunt chest trauma.

RESULTS

The reported incidence of these injuries varied widely, most injuries were related to rapid deceleration injuries or falls. Diagnosis depends on a high level of clinic suspicion and appropriate investigations include helical CT scanning and arteriography. Treatment options have expanded in recent years with the use of endovascular stents; however, the optimal treatment remains uncertain.

CONCLUSIONS

Aortic branch injuries must be actively excluded in patients with suspicious mechanisms of injury. Guidelines determining appropriate investigative pathways and methods of treatment should be developed at all trauma centres.

[Spontaneous thrombosis of an iatrogenic pseudoaneurysm of the arterial brachiocephalic trunk following central venous catheterization]

Following the unsuccessful puncture of the right subclavian vein during central catheterism, a 80-year-old women developed a pseudoaneurysm on the external face of the brachiocephalic artery. Her symptomatology and haemodynamic status having remained steady, the patient was closely observed. The pseudoaneurysm itself thrombosed spontaneously and the foreseen endovascular procedure doesn't have been achieved. A review of the literature has been done concerning the venous catheterism complications and the pseudoaneurysm treatment.

Traumatic vascular injuries and their management

Traumatic vascular injury to the intracranial and extracranial circulation can be sequelae of blunt, penetrating, or iatrogenic insults to the head, face, or neck. Treatment options include conservative medical management, or more invasive surgical or endovascular therapy. The appropriate treatment depends on the risk-benefit ratio of each option considering the natural history of each. Injuries include mild intimal irregularities, intimal flaps, pseudoaneurysms, fistulas, and occlusions. Need for treatment is partly determined by the collateral circulation to the brain, and the degree to which the lesion is thrombogenic. Advances in endovascular devices and techniques provide us with less invasive alternatives to surgery intervention or allow the interventionalist to treat lesions not treatable by any other modality.