Surgical management of a patient with an innominate artery pseudoaneurysm secondary to blunt trauma.
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0314
Submission Type:
Abstract Submission
Authors:
Luke Holland (1), Karim Brohi (2), John Yap (1), Benjamin Adams (1)
Institutions:
(1) Department of Cardiothoracic Surgery, Barts Heart Centre, St Bartholomew's Hospital, London, UK., London, NA, (2) Royal London Hospital, London, NA
Submitting Author:
Luke Holland
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Department of Cardiothoracic Surgery, Barts Heart Centre, St Bartholomew's Hospital, London, UK.
Department of Cardiothoracic Surgery, Barts Heart Centre, St Bartholomew's Hospital, London, UK.
Co-Author(s):
Karim Brohi
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Royal London Hospital
Royal London Hospital
John Yap
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Department of Cardiothoracic Surgery, Barts Heart Centre, St Bartholomew's Hospital, London, UK.
Department of Cardiothoracic Surgery, Barts Heart Centre, St Bartholomew's Hospital, London, UK.
Benjamin Adams
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Department of Cardiothoracic Surgery, Barts Heart Centre, St Bartholomew's Hospital, London, UK.
Department of Cardiothoracic Surgery, Barts Heart Centre, St Bartholomew's Hospital, London, UK.
Presenting Author:
Luke Holland
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Hammersmith Hospital
Hammersmith Hospital
Abstract:
Objective: Blunt force traumatic injuries to the aortic arch and great vessels are relatively rare, but are often fatal. The fact that they are encountered infrequently, coupled with their location, makes them a particular surgical challenge. Our objective is to present an unusual case of a traumatic pseudoaneurysm of the innominate artery, outline the options for repair, and discuss the technicalities of the operation in conjunction with intraoperative images.
Methods: A 17-years-old male was taken by ambulance to a district general hospital emergency room, having sustained polytrauma following a motorcycle collision. His primary injuries at presentation included a right forearm fracture with deformity, an open tibia/fibula fracture with distal neurovascular compromise, T4 & T5 fracture, craniofacial fractures and lung contusions. On transfer to our tertiary trauma centre, a repeat CT angiogram identified an expanding 23 x 15 x 7 mm pseudoaneurysm arising from the anterior surface of his innominate artery extending to the proximal right common carotid artery (figure 1). An ad hoc aortovascular MDT was held, and the patient was consented for repair of his innominate artery with or without aortic arch replacement under circulatory arrest
Results: In the operating room, a right total sternoclavicular joint dislocation was identified as the probable cause of the underlying vascular injury. On opening the chest, there was a frank hemopericardium and bruising to his innominate artery. After dissection of the great vessels, vascular clamps were applied to the right common carotid and right subclavian arteries beyond the point of injury, along with the base of the innominate artery at the take-off from the arch. It was deemed that injury could be repaired without arch surgery or circulatory arrest. The patient was placed on cardiopulmonary bypass. On opening the adventitia, a complete rupture of the innominate intima and media was identified. The artery was resected and a 10 mm Gelweave interposition graft implanted. Cerebral saturation monitoring was stable throughout. On waking, the patient was neurologically intact and post-operative imaging was satisfactory. He was discharged home 16 days later.
Conclusions: Innominate artery trauma is a rare presentation, but should be considered in high velocity blunt trauma leading to sternoclavicular joint dislocation. This case, along with radiological and intraoperative imaging, illustrates the decision making and surgical skills necessary for an aortovascular surgeon to manage such patients.
Methods: A 17-years-old male was taken by ambulance to a district general hospital emergency room, having sustained polytrauma following a motorcycle collision. His primary injuries at presentation included a right forearm fracture with deformity, an open tibia/fibula fracture with distal neurovascular compromise, T4 & T5 fracture, craniofacial fractures and lung contusions. On transfer to our tertiary trauma centre, a repeat CT angiogram identified an expanding 23 x 15 x 7 mm pseudoaneurysm arising from the anterior surface of his innominate artery extending to the proximal right common carotid artery (figure 1). An ad hoc aortovascular MDT was held, and the patient was consented for repair of his innominate artery with or without aortic arch replacement under circulatory arrest
Results: In the operating room, a right total sternoclavicular joint dislocation was identified as the probable cause of the underlying vascular injury. On opening the chest, there was a frank hemopericardium and bruising to his innominate artery. After dissection of the great vessels, vascular clamps were applied to the right common carotid and right subclavian arteries beyond the point of injury, along with the base of the innominate artery at the take-off from the arch. It was deemed that injury could be repaired without arch surgery or circulatory arrest. The patient was placed on cardiopulmonary bypass. On opening the adventitia, a complete rupture of the innominate intima and media was identified. The artery was resected and a 10 mm Gelweave interposition graft implanted. Cerebral saturation monitoring was stable throughout. On waking, the patient was neurologically intact and post-operative imaging was satisfactory. He was discharged home 16 days later.
Conclusions: Innominate artery trauma is a rare presentation, but should be considered in high velocity blunt trauma leading to sternoclavicular joint dislocation. This case, along with radiological and intraoperative imaging, illustrates the decision making and surgical skills necessary for an aortovascular surgeon to manage such patients.
Aortic Symposium:
Trauma
Image or Table
