Innominate Artery Injury Research Articles

Treatment of Iatrogenic Innominate Artery Injury with Physician-modified Endograft

Treatment of Iatrogenic Innominate Artery Injury with Physician-modified Endograft

Craniomaxillofacial Trauma Surgery Track: Innominate Artery Injury During Tracheostomy: A Case Report and Literature Review

Craniomaxillofacial Trauma Surgery Track: Innominate Artery Injury During Tracheostomy: A Case Report and Literature Review

Hybrid Repair Of An Innominate Artery Pseudoaneurysm After Blunt Traumatic Injury In A Bovine Arch

Innominate artery injury is an uncommon consequence of blunt trauma to the neck due to its protected position behind the thorax. A 38-year-old male presented as a trauma with a right-sided pseudoaneurysm emanating from the distal innominate artery after falling from a three-story building. On imaging, he was also found to have a bovine arch. He underwent hybrid repair with stent placement from the common carotid into the innominate artery, carotid-subclavian bypass, and plugging of the subclavian artery.

Endovascular treatment of axillosubclavian arterial injuries is a safe alternative to open repair

BackgroundInjuries to the axillosubclavian arteries are rare, comprising 5% of all extremity trauma. This study aims to examine contemporary outcomes of traumatic axillosubclavian injuries. MethodsA retrospective review was performed on patients admitted with innominate, subclavian, and/or axillary artery injuries to a level 1 trauma center from 2011 to 2021. Patients undergoing endovascular repair were compared to those with open repair. ResultsThirty two patients met inclusion criteria. Injuries were approached open in 22 (59%) cases and endovascular in 10 (27%). There was no difference in 30-day mortality or hospital length of stay between endovascular and open repair. Endovascular repairs had shorter operative times (1.9 vs 3.1 h, p = 0.009) and lower blood loss (72 vs 1662 mL, p < 0.001). ConclusionsEndovascular repair of axillosubclavian arterial injuries demonstrate similar outcomes to open repair. Significantly shorter operative times and lower blood loss suggest potential decreased morbidity.

Blunt Traumatic Innominate Artery Pseudoaneurysm Endografting without Heparin Due to Severe Brain Injury.

Blunt traumatic innominate artery injuries occur in polytrauma victims who have suffered high-speed motor vehicle collisions. Their associated injuries may preclude the use of heparin and affect surgical management and perioperative neurological risk. The uniqueness of this case is combining the arterial injury repair with a severe progressive neurological injury that prohibited standard perioperative antiplatelet or anticoagulent use.

Blunt Trauma to Brachiocephalic Artery: Presentation and Management.

Isolated innominate artery injury is very rare and accounts for less than 3% of recognized arterial injuries. Surgical exploration of the artery, especially at the origin of the artery from the arch of the aorta, is surgically challenging. Due to its rarity, any 1 surgeon's experience in dealing with innominate artery injury is bound to be limited. We report 2 cases of innominate artery injury post-blunt chest trauma. Both patients underwent thoracotomy and innominate artery Dacron graft repair and both had an uneventful postoperative course.

Endovascular Repair of Blunt Traumatic Innominate Artery Transection With a Covered Stent-Graft

Blunt traumatic injury to the innominate artery is relatively rare. Isolated innominate artery injury represents the second most common traumatic thoracic great vessel injury after that of the aorta. We present the a case of 20-year-old female patient who was involved in a motor vehicle collision with innominate artery transection identified on computed tomography (Fig 1). Because of her concomitant cerebral injury, she was deemed at extremely high risk of postoperative neurologic dysfunction should she undergo open surgical repair. Using intravascular ultrasound and angiography, the lesion was evaluated endovascularly (Fig 1), and covered stents were deployed across the lesion (Fig 2). The patient tolerated the procedure well, without the need for open repair via sternotomy, and was discharged without any complications. Duplex ultrasound scans at 1- and 6-month intervals showed satisfactory results. We have demonstrated that endovascular repair of innominate artery injuries can be considered a feasible alternative to open repair for patients with blunt traumatic innominate artery injury.Fig 2The covered stents successfully isolated the innominate artery injury.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Endovascular treatment of concomitant innominate and subclavian artery injury with pseudoaneurysms from a gunshot wound in a polytrauma patient

Introduction Injury of the innominate artery (IA) is associated with high mortality and morbidity, such as a major neurologic event. The aim of this case report was to describe an example of prioritization in polytrauma management by applying endovascular intervention in a difficult case with impending uncal herniation, extensive cerebral infarction, and large pseudoaneurysm from concomitant innominate and right subclavian artery injuries. Case Report A 34-year-old woman sustained a gunshot wound to her upper chest that lodged in the anterior triangle of her neck and presented with tension pneumothorax and cardiac arrest, which was successfully resuscitated. Subsequently she developed drowsiness and left hemiparesis, and computerized tomography demonstrated a large right cerebral hemisphere and left cerebellar region infarction with impending uncal herniation and pseudoaneurysms from the IA and proximal right subclavian artery. After emergency craniectomy to avert herniation, endovascular treatment was performed to facilitate vessel repair due to anatomical difficulty and the patient’s unstable condition. She was discharged home 3 weeks after operation, and 2 months postoperatively, she was neurologically intact with no evidence of endoleakage or pseudoaneurysm. Conclusion In such a complex polytrauma case, correct prioritization of interventions is crucial to obtaining the best outcomes, and the Endovascular Resuscitation and Trauma Management protocol can be applied as an alternative treatment protocol with good results.

Evaluation of Subclavian, Thoracic Aorta, and Innominate Artery Injuries in Blunt Trauma Mechanisms: A Systematic Review of Case Reports and Case Series

Background: Blunt thoracic arterial injuries are one of the uncommon presentations in trauma clinical experiences. Most reports are case reports and case series and no significantly consolidated data is available. This is an attempt to organize case reports and case series. Methodology: Pubmed and Google scholar were utilized to find case reports and case series on each artery separately with data search limited to publications between 2000 and 2019. The retrieved data are extracted using tables with specific components for data interpretation and the data was finally entered and analyzed using SPSS version 23. Results: The mean ages were between 35.9 and 44.3 years with male proportions were 76.5% to 89.7% across the three groups of patients. Motor vehicle related injuries contributed between 49.9% and 81.2%in the three groups. Blood pressure/pulse deficit was recorded in 34.8% and 20,7% of patients with Subclavian and Innominate artery injuries respectively with chest pain and hemodynamic instability found in 23.5% and 20.5% of Aortic injury patients respectively. Clavicular fracture was evident in 42.2% of Subclavian artery injury patients. Computed tomography was performed in 21.7%, 47.1%, 27.6% of patients with Subclavian artery, Aortic and Innominate artery injuries respectively. Endovascular procedure was performed in 44.1% of patients with Subclavian artery injury. Conclusion: Injury to Subclavian artery is relatively common among older population. Blood pressure or pulse discrepancy could point to either Subclavian or Innominate artery injury. Computed Tomography can be efficiently used in all the Arteries but there is poor experience regarding its use in Innominate artery injuries for this reason lower threshold for Conventional angiography should be preferred. Endovascular procedure can be considered in all patients but has to be individualized based on patient and facility factors. Keywords: Aortic rupture; clavicular fracture; traumatic pseudoaneurysm; endovascular repair; cerebrovascular accident

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.

Innominate artery injury during routine laser assisted lead extraction

Laser assisted lead extraction is a relatively safe procedure; however, it is an invasive procedure which could involve significant increase in morbidity and mortality associated with risk of concomitant arterial and venous injuries. We report a 69-year-old patient sustained an iatrogenic perforation to subclavian vein and transection of the innominate artery during laser lead extraction, necessitated commencing cardiopulmonary bypass and repair of the injuries.

EndoVascular and Hybrid Trauma Management (EVTM) for Blunt Innominate Artery Injury with Ongoing Extravasation.

Innominate artery (IA) traumatic injuries are rare but life-threatening, with high mortality and morbidity. Open surgical repair is the treatment of choice but is technically demanding. We describe a case of blunt trauma to the IA with ongoing bleeding, treated successfully by combined (hybrid) endovascular and open surgery. The case demonstrates the immediate usage of modern endovascular and surgical tools as part of endovascular and hybrid trauma management.

Damage control management of innominate artery injury with tracheostomy.

Innominate artery injury is a rare, but catastrophic complication of tracheostomy. We present a case of severe hemorrhagic shock in a 79-year-old male with innominate artery injury that occurred during tracheostomy. Despite temporary innominate artery isolation, the regional forehead saturation was 60 % without laterality. Because adequate cerebral blood flow was apparently maintained through collateral flow, we ligated the innominate, right carotid, and subclavian arteries. We confirmed adequate blood flow to the brain and the right subclavian artery through collateral circulation after ligation using computed tomographic angiography. A damage control management, which involves ligating the injured innominate artery to arrest hemorrhage and monitoring regional forehead saturation for brain ischemia, can be a considerable procedure for the treatment of severe hemorrhagic shock due to innominate artery injury.

Case Report: Stab Injuries in the Neck Involving the Innominate Artery

Case Report: Stab Injuries in the Neck Involving the Innominate Artery Isolated innominate artery injuries caused by stab wounds are uncommon, but otolaryngologists may still encounter these injuries. The present report describes the case of an 80-yearold woman with a history of rheumatoid arthritis that was referred to our department after sustaining a stab injury to the innominate artery during a suicide attempt. On admission, she was hemodynamically unstable, and injury to the great vessels was suspected. Urgent surgical exploration through anterior neck incision was performed. Thoracic surgeons were consulted, because there was extensive hematoma in the neck and extending to the thorax with continuous active bleeding. A bleeding point was found in the distal part of the innominate artery, and the defect was immediately sutured with a prosthetic patch. Seven weeks after surgery, the patient presented with continuous oozing of blood from a posttraumatic aneurysm in the proximal part of the innominate artery. Emergent surgery was performed to achieve hemostasis and to replace the aneurysmal lesion with an interposition graft. Unfortunately, she expired intraoperatively due to uncontrollable bleeding. Vascular vulnerability based on systemic rheumatoid inflammation caused the outcome to worsen. Otolaryngologists should be aware that stab injury to the neck can result in death, even if the wound appears minor externally. The importance of diagnostic modalities, and cooperation with thoracic surgeons as well as the difficulty in predicting delayed complications followed innominate artery injury are discussed. Isolated innominate artery injuries caused by stab wounds are uncommon, but otolaryngologists may still encounter these injuries. The present report describes the case of an 80-yearold woman with a history of rheumatoid arthritis that was referred to our department after sustaining a stab injury to the innominate artery during a suicide attempt. On admission, she was hemodynamically unstable, and injury to the great vessels was suspected. Urgent surgical exploration through anterior neck incision was performed. Thoracic surgeons were consulted, because there was extensive hematoma in the neck and extending to the thorax with continuous active bleeding. A bleeding point was found in the distal part of the innominate artery, and the defect was immediately sutured with a prosthetic patch. Seven weeks after surgery, the patient presented with continuous oozing of blood from a posttraumatic aneurysm in the proximal part of the innominate artery. Emergent surgery was performed to achieve hemostasis and to replace the aneurysmal lesion with an interposition graft. Unfortunately, she expired intraoperatively due to uncontrollable bleeding. Vascular vulnerability based on systemic rheumatoid inflammation caused the outcome to worsen. Otolaryngologists should be aware that stab injury to the neck can result in death, even if the wound appears minor externally. The importance of diagnostic modalities, and cooperation with thoracic surgeons as well as the difficulty in predicting delayed complications followed innominate artery injury are discussed.

Blunt traumatic injury of the innominate artery resulting in a stroke – A rare presentation

IntroductionBlunt traumatic injury of innominate artery is uncommon and has been reported only in 132 cases. In the literature there has been a solitary case report of a stroke resulting from an innominate artery injury. We present a case of traumatic injury of the innominate artery resulting in an ischemic stroke. Case presentationA 20-year-old gentleman ejected from a two wheeler and run over by a truck presented to us with multiple bleeding facial wounds and severe crush injury of his upper torso. Bedside chest X-ray revealed a widened mediastinum and multiple rib fractures with pneumothoraces bilaterally which were drained with intercostal tubes. An hour into his stay in the ED he developed left hemiparesis. CT brain showed infarcts in right temporo-parietal and occipital regions. CT angiogram of neck vessels revealed an avulsion injury at the origin of the right innominate artery with pseudoaneurysm formation. DiscussionThe innominate artery is the 2nd most common site of great vessel injury after the ascending aorta. 71% die before reaching the hospital. Patients who present to the ED are often stable with associated major injuries including rib fractures, pneumothorax and closed head injuries. The diagnosis is aided by a thorough clinical examination or a chest X-ray revealing a widened mediastinum as seen in our patient. Lessons learntSevere upper torso injuries involving the clavicle and upper ribs with pulse deficits or unexplained neurology should always raise a strong suspicion of major vascular injuries warranting further evaluation.

Blunt Partial Transection of the Innominate Artery

Introduction Innominate artery injury occurs, although rare. The innominate artery is the second most common aortic vessel injured as a result of blunt trauma. A blunt mechanism has been associated with up to 35% of innominate artery injuries. Associated innominate artery injuries include aortic or aortic branch injury, pneumothorax, rib fracture, head trauma, and long bone extremity fracture. Traditionally, surgical correction has been the preferred management option. Surgical options include the use of a graft verses primary repair, a bypass exclusion technique, cardiopulmonary bypass, and profound hypothermia or shunts, especially to maintain or protect cerebral perfusion. Stenting is another treatment option. The use and timing of these interventions depends on the characteristics of the innominate artery injury, associated concomitant injuries, resources of the facility, and comfort level of the surgeon. The branching pattern of the human aortic arch is varied. These variations should be kept in mind when dealing with great vessel injuries. The term “bovine arch” will not be used to describe the aortic arch branching pattern anomaly found in the current case as a true bovine arch involves a large brachiocephalic trunk that gives rise to both subclavian arteries and a bicarotid trunk. Two forms of human anomalous arch anatomy have been described as a bovine arch. The first arch variant is characterized as having a common origin of the innominate artery and the left common carotid artery. In a report by Layton and colleagues, they indicated that this variant occurred in approximately 13% of patients. He also reported that the second variant, in which the origin of the left common carotid artery arises from the innominate artery, occurs in less than 10% of the general population. The presence of these anomalies may contribute to the location of a great vessel injury as well as influence the management of the resulting injury in regards to maintaining cerebral perfusion. We report the case of an innominate artery injury in a man with anomalous arch circulation and our management of the injury.

Innominate artery injury from disseminated tuberculosis

A 49-year-old man presented with chest pain and was found to have hemorrhage and drainage from a chest wound secondary to disseminated tuberculosis involving the sternum and ankle. He then developed acute hemorrhage from an innominate artery pseudoaneurysm originating just below a severely diseased sternoclavicular junction. A staged approach was used to manage his pathology given the life-threatening bleeding and his debilitated condition. He underwent endovascular stent grafting to exclude the pseudoaneurysm, followed by aggressive debridement of the affected sternal area.

Repair of Traumatic Aortoinnominate Disruption Using CorMatrix

Blunt traumatic injuries to the innominate artery are rare but potentially devastating injuries. Patients with an innominate injury who survive typically have an isolated intimal tear with an intact adventitia. There are multiple case reports and series describing off-pump repair of innominate injuries using synthetic grafts, and even reports of successful endovascular stenting. We report the first successful case of innominate artery disruption and repair using CorMatrix (CorMatrix Alpharetta, GA) extracellular matrix.

Pseudoaneurysm of the Proximal Innominate Artery after Blunt Trauma

Pseudoaneurysm of the Proximal Innominate Artery after Blunt Trauma

Traumatic Injury of the Innominate Artery: A Case Report

The innominate artery (the right brachiocephalic artery) is an aortic branch. From this artery, right carotid artery and subclavian artery are bifurcated. This artery is short and relatively well protected by the bony thorax. However, injury of this artery is not uncommon. Several cases with innominate artery injuries have been documented involving blunt traumatic injury such as motor vehicle accidents or penetrating injuries. In those cases, it isn’t difficult to anticipate injuries to great vessels or determine approaches to investigate injuries, because of their trauma history, typical symptoms, and other associated injuries. However, recently we experience a case that it appeared to be no explicit blunt trauma history, his symptoms and signs were not specific, and after the postmortem examination, the innominate arterial injury was the only isolating injury. Thus, it wouldn’t have been easy to suspect this type of injury at the beginning. During autopsy procedure, looking for this injury pattern or searching for this type of injury might have also been neglected or missed. Therefore, we presented our unusual case with review of literature.