Blunt injury of the innominate artery and left innominate vein

Davidović, Lazar; Ilić, Nikola; Cvetković, Slobodan; Končar, Igor; Čolić, Momčilo; Vjestica, Milica

doi:10.1258/vasc.2010.cr0236

Cited by 8 publications

(8 citation statements)

References 10 publications

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“…The most accepted are: the shearing force produced by hyperextension of the neck and rotation of the head causing longitudinal tension of the innominate artery; and the anteroposterior compression of the space between the sternum and the vertebral column with displacement of the heart posteriorly and to the left side of the chest producing tension in the aortic arch and outlet vessels. 1,2,4,8 However, in the present case, the patient suffered a distal injury of the IA, a rare pattern with the possible mechanism involving the direct force of the dislocated clavicle (fractured in this case) against a maximally stretched IA by sudden deceleration. 4 Patients with IA injury usually have multiple associated injuries with the most commonly described being concomitant aortic or aortic branch injury, rib fracture, pneumothorax, head trauma, long extremity bone and clavicle fractures.…”

Section: Discussionmentioning

confidence: 64%

“…7 The proximal portion of the IA is the most affected 2-4,7 and can produce different pathological findings, with varying degrees of injury to the intima and to the media and with or without pseudoaneurysm formation. 1, 4 Several injury mechanisms have been proposed. The most accepted are: the shearing force produced by hyperextension of the neck and rotation of the head causing longitudinal tension of the innominate artery; and the anteroposterior compression of the space between the sternum and the vertebral column with displacement of the heart posteriorly and to the left side of the chest producing tension in the aortic arch and outlet vessels.…”

Section: Discussionmentioning

confidence: 99%

“…Innominate artery (IA) injury is a rare but potentially life-threatening emergency. It is estimated that 71% of the patients with this injury die before reaching hospital care 1 and another 10-25% will die despite reaching advanced medical care. 2 The first report of traumatic IA injury was in 1932 when ligation was the recommended treatment.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Covered Endovascular Repair of Innominate Artery Bifurcation After Thoracic Blunt Trauma

Gouveia

Dias-Neto

Duarte-Gamas

et al. 2020

Vasc Endovascular Surg

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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.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Covered Endovascular Repair of Innominate Artery Bifurcation After Thoracic Blunt Trauma

Gouveia

Dias-Neto

Duarte-Gamas

et al. 2020

Vasc Endovascular Surg

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“…8 Furthermore, depending on the extension of the lesion (eg, whether it involves the aortic arch), several modalities may be considered, varying from interposition bypass grafting with or without shunts and with or without cardiopulmonary bypass with hypothermic arrest, to combined endovascular and open repairs, or to pure endovascular repair. 12,14,17,18 Since all of these options could be offered at our center, including a pure endovascular and hybrid thoracic aortic repair, 19 a truly patient-tailored approach was the aim.…”

Section: Discussionmentioning

confidence: 99%

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

Dias-Neto

Ramos

Teixeira

2018

Vasc Endovascular Surg

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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.

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“…Although IA injury is second most common after aortic isthmus, there are less than 150 cases reported in the literature. 1 IA ostium is most commonly involved, as it is fixed to aortic arch as compared with distal IA. The ostium of IA gets stretched as it is trapped between the sternum or sternoclavicular joint anteriorly and vertebral column posteriorly with leftward shift of heart, resulting in tear or dissection with or without pseudoaneurysm formation.…”

Section: Descriptionmentioning

confidence: 99%