Innominate artery trauma: A thirty-year experience

Abstract

Patients with innominate artery injury and stable vital signs can usually be transported without difficulty and treated without complex perioperative adjuncts. These patients can undergo revascularization with simple vascular surgical techniques and should expect an uncomplicated postoperative course unless there has been associated central nervous system injury or related injuries leading to systemic infection. Synthetic conduits have been used with success and have not required systemic heparinization or complex temporary shunting.

Vasoactive Intestinal Polypeptide and Gastrin-Releasing Peptide Attenuate Hepatic Microvasculatory Disturbances following Intestinal Ischemia and Reperfusion

“…Previous work on similar models of gut IIR has shown that reduced hepatic blood flow and oxygen consumption alone, occurring as a result of diminished contribution of SMA to portal vein flow, cannot explain the subsequent liver dysfunction (e.g., reduced bile flow) [18]. Pronounced changes in microcirculation and bile flow can rather be explained by the presence of circulating inflammatory mediators, including oxidants [19], neutrophils [2, 5]complement fragments [2, 19]and cytokines [5], which are activated during and after reperfusion and thus may have contributed to an increase in WBC-endothelial interactions and a decrease in the sinusoidal perfusion rate in the liver. The local release of vasoactive eicosanoids (e.g.…”

“…Intestinal ischemia followed by reperfusion not only leads to functional problems of the small bowel itself but also affects organs not primarily involved, in particular the kidney, lung and liver. Alterations in the microcirculation of these organs result in anything from dysfunction during the postoperative phase to multiple organ failure syndrome [2, 3, 4]. The reperfusion of ischemic intestine is associated with an acute hepatic injury, characterized by hepatocellular enzyme release [2], reduced bile flow, metabolic dysfunction and an increase in hepatic microvascular permeability [5].…”

“…Alterations in the microcirculation of these organs result in anything from dysfunction during the postoperative phase to multiple organ failure syndrome [2, 3, 4]. The reperfusion of ischemic intestine is associated with an acute hepatic injury, characterized by hepatocellular enzyme release [2], reduced bile flow, metabolic dysfunction and an increase in hepatic microvascular permeability [5]. These characteristics are a result of circulating inflammatory mediators such as oxidants, activated complement fragments and cytokines on the one hand, and leukocytes activated during intestinal reperfusion on the other [5].…”

Blunt innominate artery trauma requiring repair and carotid ligation

“…Innominate injuries have a high morbidity and mortality, in part due to their inaccessibility, associated injuries, potential for cerebrovascular hypoperfusion and stroke, and relative inexperience of most surgeons dealing with these injuries. In-hospital mortality rate varies between 5 and 43% [2] .…”

Report of the Second Bi-monthly Virtual Meeting of the Iranian Society of Cardiac Surgeons: Investigation of Three Interesting Cases

“…The most common mechanism of injury is motor-vehicle accidents. Head-on collisions constitute the majority at speeds of more than 60 mph or change in speeds of greater than or equal to 20 mph (6).…”