Traumatic disruption of the brachiocephalic artery

Dula, David J.; Hughes, Howard G.; Majernick, Thomas G

doi:10.1016/s0196-0644(83)80213-3

Cited by 5 publications

(8 citation statements)

References 16 publications

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“…Blunt or deceleration trauma [1,2], operative injury during tracheal surgery [3] or tracheostomy [4], tumor invasion [5], radiotherapy [6], invasive infections [7], tubercular pseudoaneurysms [8], heritable abnormalities of connective tissue like Ehlers- Danlos syndrome [9], bovine aortic arch [10,11], innominate artery aneurysms, caused variously by Takayasu disease, degenerative disease, Syphilis, trauma, Marfan disease and dissection [12] can all result in innominate trunk rupture.…”

Section: Discussionmentioning

confidence: 99%

Innominate truncal and arch blowout with left hemiparesis and right hemothorax followed by delayed cheese-wire perforation of innominate graft

Kaul

Paniagua

2013

J Cardiothorac Surg

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We present the case of a 68 year old Caucasian woman, in extremis, with left hemiparesis and right hemothorax, in hypovolemic shock, secondary to a blow-out of a large penetrating ulcer at the junction of innominate trunk and aortic arch. She underwent interposition graft replacement of innominate trunk and repair of aortic arch, on cardiopulmonary bypass, employing total circulatory arrest and selective antegrade cerebral perfusion and had total resolution of hemiparesis. She, however, represented, 6 months later, with threatened exsanguination after a sternal wire cheese-wired through the sternum and perforated the anteriorly lying innominate graft. Following successful repair, she was found to have an old intramural hematoma of distal arch and descending thoracic aorta and changes suggestive of chronic dissection of the whole of abdominal aorta. This was managed conservatively.We believe this patient’s presentation initially with a spontaneous innominate blow-out, cardiogenic shock, hemothorax and hemiparesis, and later with cheese-wire perforation of the innominate graft is unique. Her surgical rescue at both presentations was equally unusual, and without surgical precedent to the best of our knowledge. Was the initial innominate blow-out the result of localised innominate dissection, or more unusually, part of retrograde descending thoracic dissection with skip penetration of innominate artery and sparing of the intervening arch? Was it secondary to the minor fall she had sustained 1 week prior to the event, resulting in a false aneurysm or a contained hematoma next to the innominate artery? More intriguingly, did diffuse aortopathy underpin these diverse etiologies and result in penetrating intimal ulcer with blow out in the innominate artery, intramural hematoma in the arch and descending thoracic aorta and dissection in abdominal aorta at different points in time?We review the current literature for these unusual afflictions of innominate trunk and its origin from the arch of aorta.

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Section: Discussionmentioning

confidence: 99%

Innominate truncal and arch blowout with left hemiparesis and right hemothorax followed by delayed cheese-wire perforation of innominate graft

Kaul

Paniagua

2013

J Cardiothorac Surg

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“…Outras teorias em relação ao mecanismo de trauma são a lesão direta da artéria, avulsão do manúbrio esternal, luxação interna da cabeça proximal da clavícula 10 e desaceleração abrupta associada a extensão do pescoço causando um estresse na origem do tronco braquiocefálico 13,15,16 .…”

Section: Discussionunclassified

“…Dependendo da deformidade plástica infringida ao vaso, podem ocorrer vários tipos de lesões, sendo a avulsão da íntima com vários graus de lesão na média e adventícia, com ou sem formação de pseudoaneurisma, a lesão mais comum. Esse tipo de lesão é mais freqüentemente observada no ístmo da aorta, sendo a parte proximal do tronco braquiocefálico o segundo local mais comumente acometido 10,12,13,14,15,16,17 . A formação do pseudoaneurisma requer lesão de íntima e média com adventícia intacta e como a adventícia é fraca, o pseudoaneurisma pode romper-se facilmente 13 .…”

Section: Discussionunclassified

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Lesão do esôfago e de tronco braquiocefálico em trauma fechado: uma associação incomum

Kobata

Neves

Rocha

et al. 2004

Rev. Med. (São Paulo)

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Relato de lesão incomum de esôfago e rara associação desta com lesão em tronco braquiocefálico (TBC) em paciente vítima de trauma fechado. Paciente vítima de acidenteautomobilístico (auto x caminhão), masc., 19a., passageiro do banco traseiro do auto e sem cinto de segurança. Chegou ao PSHC-FMUSP consciente, orientado e estável hemodinamicamente. Exames iniciais evidenciaram alargamento de mediastino. À arteriografia, identificou-se alargamento proximal de TBC sugestivo de pseudoaneurisma e à endoscopia, duas lesões esofágicas de aproximadamente 6cm que acometiam a serosa e a muscular, mas poupavam a mucosa. Foi submetido a uma esternotomia para enxerto do TBC e posterior toracotomia ântero-lateral para correção das lesões esofágicas. Evoluiu bem, sem intercorrências significativas, recebendo alta no 10o PO. Consideram os autores, após revisão da literatura, que lesões de esôfago e de TBC causados por trauma fechado são individualmente raras e, a associação das lesões não foi observada na literatura estudada.

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“…Innominate trunk rupture can follow a variety of disease processes. Blunt or deceleration trauma 18,19 , operative injury during tracheal surgery 20 or tracheostomy 21 , tumor invasion 22 , radiotherapy 23 , invasive infections 24 , tubercular pseudoaneurysms 25 , heritable abnormalities of connective tissue like Ehlers-Danlos syndrome 26 , bovine aortic arch 27,28 , innominate artery aneurysms (IAA), caused variously by Takayasu disease, degenerative disease, syphilis, chronic dissection, trauma and Marfan disease 29 , can all result in innominate trunk rupture. Although, as reported in a large retrospective study by Neri et al 17 , as many as 30% of patients who underwent type A dissection repair had brachiocephalic dissection, innominate involvement is hardly ever complicated by rupture.…”

Section: Case Presentationmentioning

confidence: 99%

Innominate truncal dissection and rupture into right pleural cavity following acute type A dissection of the aorta with right coronary ostial avulsion and inferior STEMI

et al. 2011

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An innominate truncal dissection and rupture into the right pleural cavity with massive hemothorax is the initial presentation in this 66-year-old lady with type A dissection of the aorta complicated by right coronary ostial avulsion and inferior STEMI. She underwent supracoronary interposition graft replacement of the ascending aorta and hemiarch, interposition graft replacement of the innominate trunk and saphenous vein bypass grafting of the right coronary artery successfully. Innominate truncal rupture following aortic dissection is practically unknown and has not been described before in the absence of aortic rupture. Innominate truncal rupture secondary to other pathologies presents with supraaortic and mediastinal hematomas, but almost never with right hemothorax. On the backdrop of this unusual presentation with no neurological injury, we review the literature for innominate truncal dissection and rupture, other etiologies for innominate truncal rupture, the complex interplay of factors determining neurological injury and discuss the changes in the strategies and conduct of arterial return during cardiopulmonary bypass and selective antegrade perfusion imposed by this previously undescribed instance of innominate truncal rupture due to dissection.

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Traumatic disruption of the brachiocephalic artery

Cited by 5 publications

References 16 publications

Innominate truncal and arch blowout with left hemiparesis and right hemothorax followed by delayed cheese-wire perforation of innominate graft

Innominate truncal and arch blowout with left hemiparesis and right hemothorax followed by delayed cheese-wire perforation of innominate graft

Lesão do esôfago e de tronco braquiocefálico em trauma fechado: uma associação incomum

Innominate truncal dissection and rupture into right pleural cavity following acute type A dissection of the aorta with right coronary ostial avulsion and inferior STEMI

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