Innominate artery lesions: Problems encountered and lessons learned

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Presentation transcript:

Innominate artery lesions: Problems encountered and lessons learned David C. Brewster, M.D., Ashby C. Moncure, M.D., R.Clement Darling, M.D., John J. Ambrosino, M.D., William M. Abbott, M.D. Journal of Vascular Surgery Volume 2, Issue 1, Pages 99-112 (January 1985) DOI: 10.1016/0741-5214(85)90179-X Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 1 Severe atherosclerotic stenosis in proximal innominate artery of patient with amaurosis fugax. Journal of Vascular Surgery 1985 2, 99-112DOI: (10.1016/0741-5214(85)90179-X) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 2 Large atherosclerotic innominate aneurysm presenting as mediastinal mass on routine chest x-ray film in patient admitted for abdominal aortic aneurysm. Journal of Vascular Surgery 1985 2, 99-112DOI: (10.1016/0741-5214(85)90179-X) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 3 Localized dissection of arch following aortic valve replacement and coronary bypass occluded origins of both innominate and left carotid arteries. Left subclavian—bilateral carotid extrathoracic bypass relieved repeated syncopal episodes. Journal of Vascular Surgery 1985 2, 99-112DOI: (10.1016/0741-5214(85)90179-X) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 4 Elderly patient with stridor and respiratory distress. Prolonged tracheal compression by tortuous calcified innominate artery led to severe tracheomalacia. Journal of Vascular Surgery 1985 2, 99-112DOI: (10.1016/0741-5214(85)90179-X) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 5 Large thromboembolus is seen in distal innominate and proximal subclavian arteries. Patient presented with hand ischemia secondary to distal embolization of clot fragments. Journal of Vascular Surgery 1985 2, 99-112DOI: (10.1016/0741-5214(85)90179-X) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 6 Common brachiocephalic trunk with origin of left common carotid artery from innominate artery. Journal of Vascular Surgery 1985 2, 99-112DOI: (10.1016/0741-5214(85)90179-X) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 7 A, Bifurcation graft may be utilized for grafting to both subclavian and right carotid arteries if distal innominate artery or its bifurcation is unsuitable for anastomosis. B, Use of bifurcation graft if both innominate and left common carotid arteries require reconstruction. Journal of Vascular Surgery 1985 2, 99-112DOI: (10.1016/0741-5214(85)90179-X) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 8 A, If bifurcation prosthesis too bulky for mediastinum, short side branch may be taken off upper aspect of single, smaller diameter graft. B, Similar consideration in reconstruction of both innominate and left common carotid arteries. Journal of Vascular Surgery 1985 2, 99-112DOI: (10.1016/0741-5214(85)90179-X) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions