Spontaneous innominate and left common carotid artery dissection with bovine aortic arch

Abstract

We describe a case of a 63-year-old woman who presented with spontaneous dissection of the innominate and left common carotid arteries arising from a common trunk, so-called "bovine aortic arch." The entry tear was seen in the common trunk at the origin of the innominate artery with no dissection extending into the aortic arch or the ascending aorta. The dissection was resected and total arch replacement was performed considering the aortic wall fragility complicated by the dissection.

Infrarenal to Innominate Artery Collateral Complicating a Chronic Residual Type B Dissection

“…First, it highlights unusual flow dynamics associated with an infrarenal to IA collateral blood flow that can complicate a chronic residual type B aortic dissection. The occurrence of collaterals has been previously reported [2,3]; the current case presents diagnostic and management challenges that could significantly impact patient morbidity without timely intervention. More importantly, multimodality imaging (using CTA, MRA, and ultrasound) was effective in accurately diagnosing and characterizing the FL flow patterns and extent of FL aneurysmal degeneration in this asymptomatic patient.…”

“…These may progress in a complicated fashion and result in progressive aneurysmal dilatation of the thoracic false lumen (FL). Despite the emergence of the standard endovascular approach (TEVAR) for treatment of a type B dissection, which is usually effective [1], recurrence can occur because vessel remodeling and angiogenesis creates collateral blood supplies that can impact existing flow patterns and alter the pathophysiology of residual dissections [2,3]. To our knowledge, this is the first case that describes the clinical presentation of an infrarenal to innominate artery (IA) collateral blood flow that complicated a chronic residual type B dissection, which was diagnosed in a timely manner using multimodality imaging and successfully managed through an innovative minimally invasive endovascular treatment strategy (without thoracotomy) with no neurological sequela.…”

Nonoperative Management of Brachiocephalic Artery Dissection

“…In these latter 2 groups, there are higher rates of neurological morbidity in the long-term [2,3]. There are a handful of isolated reports of patients with spontaneous innominate artery dissection, yet in these cases the indications for surgical intervention is clear [4]. These are patients with aortic arch tears, innominate artery aneurysms or pseudoaneurysms, and those with rupture of the innominate artery who require emergent intervention.…”