Surgical and Endovascular Management of Penetrating Innominate Artery Injuries

Abstract

Innominate artery injuries have high rates of morbidity and mortality. A vascular surgical approach with pre-operative angiography, when possible and careful surgical planning by a dedicated team promotes better surgical results. Endovascular and hybrid procedures can become the method of choice when treating stable patients.

Covered stents for exclusion of iatrogenic common carotid artery–internal jugular vein fistula and brachiocephalic artery pseudoaneurysm

“…Open surgery of innominate artery injury represents a formidable challenge for experienced surgeons and is associated with high morbidity and mortality rates (5–43%), mainly due to its inaccessibility 5 10. Endovascular repair using covered stents has therefore been advocated as the treatment of choice in stable patients despite the limited number of reports.…”

“…Endovascular repair using covered stents has therefore been advocated as the treatment of choice in stable patients despite the limited number of reports. However, inadvertent overstenting of CCA origin should be avoided in more distal lesions 5. Likewise, surgical treatment of an arteriovenous fistula is difficult and requires closure of the fistula with arterial and venous reconstruction.…”

“…Traditionally, management of such vascular complications consists of open surgery, which is subject to technical difficulty and a high morbidity rate 4 5. Endovascular techniques using covered stent grafts may provide a technically simple, safe, and durable solution to supra-aortic vascular injuries 5–7…”

The effect of early endovascular intervention on the outcome of traumatic vascular injuries

“…[5] Currently, stent graft implantation or coil embolization are considered to be the optimal methods of treatment for pseudoaneurysms or uncontrollable bleeding. [5][6][7][8][9][10] Arterial occlusion, AVF, and pseuoaneurysms are the late complications of gunshot injury, and these occur at rates of 12.5%, 35%, and 52.5%, respectively. Pseudoaneurysms are diagnosed in the early period of penetrating injuries, but this happens in the late period of blunt traumas.…”

“…The mean blood use in the open surgical group was six units of packed red cells per patient, and none of the stent graft group required blood transfusions for the patients' innominate arterial injuries. [10] Stent graft deployment can be performed with mild anticoagulation; therefore, the major bleeding complications observed with heparinization and blood transfusions can theoretically be avoided. [13] We performed our endovascular procedures with local anesthesia, and the mean operation time was 32.5 minutes.…”