Brachiocephalic Arterial Trunk Research Articles

Neurological Complications of Infective Endocarditis: Beware Of Intracerebral Mycotic Aneurysms, Case Report

The modal branching pattern of the aortic arch in humans consists of three large vessels arising from the aorta, which are: the brachiocephalic arterial trunk, the left common carotid artery, and the left subclavian artery. Birth defects of the supra-aortic vessels are usually asymptomatic and incidental. We report two cases of this variant of the normal.

Common origin of the brachiocephalic arterial trunk and the left common carotid artery: two cases and review of the literature

The modal branching pattern of the aortic arch in humans consists of three large vessels arising from the aorta, which are: the brachiocephalic arterial trunk, the left common carotid artery, and the left subclavian artery. Birth defects of the supra-aortic vessels are usually asymptomatic and incidental. We report two cases of this variant of the normal.

Origin of the Left Common Carotid Artery from the Brachiocephalic Artery Trunk

The origin of the left common carotid artery from the brachiocephalic arterial trunk is a rare anatomical malformation. We report the case of a 54-year-old man with aortic stenosis on a bicuspid aortic valve with dilatation of the ascending aorta.

Iatrogenic Acute Type A Aortic Dissection following Elective Cardiopulmonary Bypass.

We report a 62-year-old woman who was scheduled for an elective Tirone David valve sparing aortic root replacement under cardiopulmonary bypass. Within the next few hours, the patient developed bilateral acute ischemia of both lower limbs. A thoracic and abdominopelvic computed tomography scan showed acute Type A aortic dissection with a perforation at the brachiocephalic arterial trunk and a complete malperfusion of the inferior mesenteric and iliac arteries.

Double fenestrated stentgrafts modified by the surgeon for totally endovascular repair of the aortic arch

The aim of this retrospective study was to evaluate the results of double fenestrated stentgrafts modified by the surgeon for the totally endovascular repair of the aortic arch, with one large proximal fenestration for the brachio-cephalic arterial trunk (BCAT) and the left common carotid artery (LCC) and a left distal fenestration for the left subclavian artery (LSCA).

Which stent to use for angioplasties of the brachio-cephalic arterial trunk?

Which stent to use for angioplasties of the brachio-cephalic arterial trunk?

Postintubation Tracheoesophageal Fistula - Diagnosis, Treatment and Prognosis.

This article focuses on a sample of 11 patients with postintubation tracheoesophageal fistula, operated in our department between 2005 and 2015. The anterior approach with tracheal resection was performed in 10 of these patients, while an atypical surgical technique was preferred in a case involving a large-sized fistula. Three of these patients were subject to surgery while still on the ventilator, in order to help weaning them from mechanical ventilation. Two patients were operated following a relapse of the fistula, after attempts of closing it in other surgical units. Results: Two patients (of those who were still on mechanical ventilation) died from intubation-related complications that persisted after tracheal resection (anastomotic dehiscence with mediastinitis and tracheoarterial fistula in the brachiocephalic arterial trunk). The nine remaining patients improved, with their airways restored and having regained normal deglutition. Conclusions: The surgical approach of this pathology is successful in surgical units that are specialised in tracheal and oesophageal surgery. Adequately timing the surgery is crucial for a good outcome.

Endo and exo aortic morphometry (endoluminal) in the aortic arch and its branches

Abstract Our study was conducted by the examination of angioCT’s, performing external measurements of aortic arch and the exo and endoaortic measurements of its three. The diameter of the thoracic aorta prior to the origin of the brachiocephalic arterial trunk was found with an average of 31.65 mm and below the left subclavian artery origin we found an average diameter of 24.3 mm. The brachiocephalic arterial trunk had an average diameter of 11.575 mm, 6.05 at carotid artery level and 9.05 mm at the level of the left subclavian artery. The endoaortic average diameter of the brachiocephalic arterial trunk: horizontally, 13.0 mm and vertically 11.7 mm; left common carotid artery horizontal diameter was 10.5 mm and 9.7 mm vertically and the left subclavian artery have 14.1 mm horizontally and 10.8 mm vertically.

The application of individualized fenestration strategy for thoracic endovascular aortic repair in aortic pathology

Objective To explore the application of individualized fenestration strategy for thoracic endovascular aortic repair in aortic pathology involving distal arch or ascending aorta with physician-modified fenestrated endografts. Methods A total of 61 patients were analyzed with aortic pathology (aortic dissection, aneurysm, and penetrating aortic ulcer) involving aortic arch or ascending aorta who underwent endovascular repair with physician-modified fenestrated endografts in a hybrid operating room between January 2013 and December 2014. Of them, 51 were Stanford type B aortic dissection, 6 were penetrating aortic ulcer in ascending aorta with intramural hematoma, 3 were thoracic descending aortic aneurysm, and one was complex lesion (thoracic descending aortic dissection plus penetrating aortic ulcer in the aortic arch). Surgeon-modified fenestration was created according to indications of fenestration and patient characteristics. Totally, fenestration for left subclavian artery (LSCA) was made in 35 cases, fenestration for left common carotid artery (LCCA) in 5, fenestration for LCCA plus LSCA in 15, and fenestration for brachiocephalic arterial trunk plus LCCA plus LSCA in 6. Results One perioperative death occurred (mortality rate, 2%). No stroke or spinal injury was reported. Follow-up computerized tomographic angiography results at 3, 6, and 12 months postoperatively showed no endoleaks and preservation of neck blood flow with fenestration. No death occurred during the 1-year follow-up period. Conclusions Endovascular repair for aortic pathology involving distal arch or ascending aorta with surgeon-modified fenestrated endografts is minimally invasive and ensures speedy patient recovery. However, further large-scale follow-up studies are required to verify its long-term efficacy. Key words: Aortic diseases/SU

Anatomy of the bovine ascending aorta and brachiocephalic artery found unfavorable for total artificial heart implant.

The biocompatibility assessment of the Cleveland Clinic continuous-flow total artificial heart is an important part of the device developmental program. Surgical and postoperative management are key factors in achieving optimal outcomes. However, the presence of vascular anatomical abnormalities in experimental animal models is often unpredictable and may worsen the expected outcomes. We report a technical impediment encountered during total artificial heart implantation complicated by unfavorable bovine anatomy of the ascending aorta and brachiocephalic arterial trunk.

Dissection traumatique du tronc artériel brachiocéphalique. À propos d’un cas

Lesions affecting the supra-aortic arterial trunks often occur in a contest of severe chest trauma. They are rarely isolated and can be life-threatening. We report a case of surgery for an isolated traumatic dissection of the innominate artery. A 48-year-old patient had a road accident causing head injury, trauma of the left lower limb and blunt chest trauma. At the physical exam, the pulse at the upper right limb was weak compared to the contralateral member. A pressure gradient of 50mm Hg was recorded between the two upper limbs. A whole body scan revealed a dissection of the innominate artery sparing its origin and bifurcation. Cervicotomy and sternotomy was necessary to achieve control. After heparinization and clamping, a prosthetic bypass was inserted to replace the innominate artery. The postoperative course was uneventful and the pressure gradient between the two upper limbs disappeared. Lesions of the brachiocephalic arterial trunk are not frequent but they are serious. A careful physical exam at admission helps detect them. Prognosis is directly linked to early diagnosis and management. Conventional surgery provides good results and remains the standard treatment for these lesions.

Morphometry of the aortic arch and its branches

Abstract Our study was conducted by the evaluation of angioCT’s performed on a GE LightSpeed VCT64 Slice CT Scanner. The measurements were performed on the aortic arch at the following levels: at the origin of the aorta, the middle part of the ascending aorta, prior to the origin of the brachiocephalic arterial trunk and after the origin of the left subclavian artery. We measured the caliber of the aortic arch arteries and the data are correlated and reported by gender. The diameter of the ascending aorta was between 27 to 28.9 mm in females and in males from 25.8 to 37.6 mm. The diameter of the aorta within the middle segment of the ascending part was between 28-30.2 mm in females and in males from 26.1 to 34.6. The diameter of the aortic arch prior to the origin of the brachiocephalic arterial trunk was between 26.4 to 29.4 mm in females and in males from 25.8 to 37.5 mm. The diameter of the aortic arch after the origin of the left subclavian artery was in a range of 20.4 to 28.4 mm, which corresponds to the limits found in males while in females the aortic diameter was between 21.3 to 24.1 mm. The brachiocephalic trunk diameters were 8.3 to 15.5 mm in females and in males was 9.1 to 14.5 mm. The right common carotid artery had a diameter of 4-8 mm diameter in males and in females ranged from 4.7 to 5.5 mm. The right subclavian artery showed a caliber of 5.7 to 7.5 mm in females and in males from 5.9 to 10.1. The left common carotid artery diameter was 4.6 to 5.7 mm in females and males the diameter was between 5.2 to 7.4 mm. The left subclavian artery had a diameter of 6-10 mm in females and in males ranged from 7.7 to 12.8 mm. We found that the distance between the ascending part of the aorta and the descending segment ranged from 33.3 to 38.5 mm in females and in males from 40 to 68.6 mm. We measured the distance that exists at the crossing of the aortic arch with the left branch of the pulmonary trunk, finding that in females this distance is 3 to 10.3 mm and in males from 3 to 12.5 mm.

Morphological characteristics of the aortic arch organization

Abstract Our study was performed on 228 cases by dissection, by plastic injection followed by corrosion or dissection and by simple and CT angiography study. Each morphological aspect was assessed on a different numbers of cases, as long as the same case could not provide data on all studied elements. We assessed: the number of branches that originate from the aortic arch, the level of origin and the morphological type of the aortic arch. In terms of number of branches emerging from the aortic arch, most commonly are three branches, in 48.48% of cases, describing them 3 variations: separation of the three classical branches in 45,96% of cases, in 1.51% of cases the left common carotid artery emerged from the brachiocephalic trunk while the other two branches being represented by a vertebral artery and the left subclavian and in 1.01% by the right subclavian artery with retroesophageal traject, by a bicarotid arterial trunk and the left subclavian artery. In 28.70% of the cases were four branches, as follows: in 13.13% of cases the fourth branch was represented by the left vertebral artery, in 7.07% of cases there was the inferior thyroid artery, in 4.04% of cases the brachiocephalic arterial trunk was missing and the right subclavian artery originate from the aortic arch and presented a retroesophageal traject, in 3.03% of cases the fourth artery was the ascending cervical and in 1.51% of cases all four arteries had their origins in the aortic arch with no brachiocephalic trunk. In 22.73% of cases from the aortic arch originated only two branches: in 19.70% of cases the left common carotid originated in the brachiocephalic trunk, so the second branch was the left subclavian and in 3.03% of the cases there were two brachiocephalic trunks. Regarding the level of origin from the aortic arch, we found that only the brachiocephalic arterial trunk showed versions of origin: in 64 61% of the cases the brachiocephalic trunk had its origin in the horizontal segment of the aortic arch, in 21.54% of cases the origin was located at the limit between the ascending and horizontal segments and vin 12.31% of cases the origin was from the ascending segment of the aortic arch. In only 1.54% of the cases the left subclavian artery originated from the descending segment of the aortic arch

Arterial Injury Complicating Subclavian Central Venous Catheter Insertion

n i a a g n c INADEQUATE PLACEMENT of a subclavian venous catheter in the subclavian artery is a well-known complication.1,2 Three cases of accidental arterial puncture occurred with the implantation of subclavian venous catheters, 2 of which involved the subclavian artery leading to percutaneous treatment; and the other involved the aortic arch, resulting in surgical management, are described.

A CASE OF AORTIC ANEURYSM

Objective: True vascular aneurysms are rare. It's a dilation of the arteries three tunics. The development of imaging techniques allowed a better characterization of these structural abnormalities. Design and method: We propose a case report. Results: A 48-year-old patient, formerly a smoker, was under a beta-blocker and an angiotensin converting enzyme inhibitor for hypertension for two years. He consulted in the emergency department for isolated diffuse abdominal pain, worsening progressively over a month. The auscultation of the supra-aortic trunks and the abdominal aorta had found a systolic-diastolic murmur. The biological assessment was without abnormalities. Chest X-ray revealed mediastinal widening. thoracoabdominal CT scan revealed multiple aneurysms of the thoracic aorta, the brachiocephalic arterial trunk, subclavian arteries, the abdominal aorta, celiac trunk, superior mesenteric artery, and left renal artery, fusiform and sacciform, some of which are partially thrombosed; the largest measuring 8 cm. Surgical intervention was considered a delayed emergency. Strict control of blood pressure was essential with close monitoring of hemodynamic status and abdominal symptomatology. As part of the etiological assessment: the morphotype did not fit with a disease of the elastic tissue; there were no signs of a systemic disease; the echocardiography was without abnormalities and the tuberculosis assessment, the syphilitic serology, the rest of the infectious balance, the inflammatory and immunological assessment were negative. The diagnosis was atheromatosis. In fact, ultrasound-doppler had revealed atheromatous plaques of several arteries without significant stenosis, and coronography had shown a stenosis of the right coronary. The patient was entrusted to the cardiovascular surgeons to schedule the necessary intervention. Conclusions: The circumstances of discovery of aortic aneurysms vary according to their seats and etiologies. The CT scan of the aorta and its branches remains the tool of choice for the positive and sometimes etiological diagnosis and for the prognosis. Although it constitutes a diagnosis by elimination, atherosclerosis remains one of the main etiologies that must be evoked in the presence of cardiovascular risk factors.