A 58-year-old male presented with back pain. On physical examination, his heart rate was 98 beats/min, blood pressure was 178/86 mmHg, his pulses were equal, and there were no murmurs.A computed tomography scan revealed an isolated innominate artery dissection with a maximum diameter of 1.6 cm (Figure 1). The patient was treated medically with strict blood pressure control and pain medication. At 6-month follow-up, he remains asymptomatic and the innominate dissection is unchanged (Figure 2). Spontaneous dissection of the innominate artery is rare.
A 56-year-old man presenting with massive melena and loss of consciousness was diagnosed with an infected thoracoabdominal aneurysm, an aortoduodenal fistula, and Leriche syndrome following an evaluation by computed tomography. Emergency surgery for uncontrolled infection included the reconstruction of the superior mesenteric and bilateral renal arteries using a four-branched graft. The aortoduodenal fistula was resected after omental filling, and an enterostomy was performed for feeding. Intestinal reconstruction was performed in two stages. The patient was discharged on postoperative day 48 and was without evidence of recurrence at 23 months postoperatively.
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