Acute dissection of the innominate artery: A case of report

Munakata, Hiroshi; Okada, Kenji; Tanaka, Hiroshi; Yamashita, Teruo; Nakagiri, Keitaro; Okita, Yutaka

doi:10.1007/s11748-007-0205-8

Cited by 13 publications

(11 citation statements)

References 6 publications

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“…[ 5 ] found excellent results with surgical management. While some reported their surgical interventions when there was concern for rupture [ 6 ], others argue for early surgical intervention in this entity [ 7 ]. Some groups recommend medical management when vessel diameter is less than 3 cm and there is no evidence of distal emboli or malperfusion [ 8 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

Management of a spontaneous supra-aortic arterial dissection: a case report

2021

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Background Acute DeBakey type I and type II aortic dissections are indications for emergent surgical repair; however, there are currently no standard protocols in the management of isolated supra-aortic dissections. Prompt diagnosis and management of an isolated innominate artery dissection are necessary to prevent distal malperfusion and thromboembolic sequelae. Case presentation A 50-year-old Caucasian gentleman presented with chest pain radiating to his jaw and right arm. He had no recent history of trauma. On physical exam, he was neurologically intact and malignantly hypertensive. Computed tomographic angiography of the chest and neck confirmed a spontaneous isolated innominate artery dissection without ascending aorta involvement. Given the lack of evidence for rupture, distal emboli, and/or end-organ malperfusion, the decision was made for initial non-operative management—anti-impulse regimen, antiplatelet therapy, and close follow-up. Conclusions Medical management of a spontaneous isolated innominate artery dissection is appropriate for short-term and potentially long-term therapy. This not only spares the patient from a potentially unnecessary surgical operation but also provides the surgeon and the patient the time to plan for a surgical approach if it becomes necessary.

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Section: Discussionmentioning

confidence: 99%

Management of a spontaneous supra-aortic arterial dissection: a case report

2021

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“…This difference, in frequency of rupture between aorta and innominate artery, is explained by Laplace’s law as well as the extrapericardial location of the innominate artery, and the support provided by the supraaortic tissues making it resistant to rupture, despite high incidence of innominate involvement in type A dissection [24]. Post traumatic innominate artery rupture has been reported after repair of type A dissection [25], as has been a rupture of innominate artery associated with a localised acute dissection, repaired with a bifurcated prosthetic graft without cerebral complications [26]. …”

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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“…In contrast, Munakata and associates described a case of acute innominate artery dissection that was treated surgically. 4 Anterior mediastinal hematoma was observed in CT scans, and replacement of the innominate artery with a Dacron graft was performed on an emergency basis because of the diagnosis of impending rupture of the dissected innominate artery.…”

Section: Discussionmentioning

confidence: 99%

Retrograde extension of common carotid artery dissection into the aortic arch

Yoshioka

Sakurai

Namai

et al. 2011

The Journal of Thoracic and Cardiovascular Surgery

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Internal carotid artery dissection is an important cause of stroke in young patients. A common carotid artery dissection is a relatively rare condition. Most dissections of the internal carotid arteries heal spontaneously with conservative treatment. However, the natural history of the common carotid artery dissection is unknown. We report a case of common carotid artery dissection followed by retrograde extension into aortic arch dissection.

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Acute dissection of the innominate artery: A case of report

Abstract: A 61-year-old man developed a ruptured innominate artery associated with localized acute dissection. The innominate artery was reconstructed with a bifurcated prosthetic graft without brain complication.

Cited by 13 publications

References 6 publications

Management of a spontaneous supra-aortic arterial dissection: a case report

Management of a spontaneous supra-aortic arterial dissection: a case report

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

Retrograde extension of common carotid artery dissection into the aortic arch

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