Surgical repair of an aneurysm of the innominate artery with fistulization into the trachea

Surgical treatment of innominate artery and aortic aneurysm: a case report and review of the literature

Innominate artery (IA) aneurysms represent 3% of all arterial aneurysms. Due to the risk of thromboembolic complications and spontaneous rupture, surgical repair is usually recommended on an early elective basis. We present the case of 81-year-old Caucasian male presenting with atypical anterior chest pain secondary to a large innominate artery aneurysm who underwent successful open surgical repair at our institution. In our experience, open correction via median sternotomy with extension into the right neck provides excellent exposure and facilitates rapid reconstruction with good short and long-term outcomes. Minimally invasive and endovascular approaches provide emerging alternatives to open IA aneurysm repair, however further research is required to better define optimal patient selection criteria and determine the long-term outcomes of these novel therapies.

Innominate artery aneurysm with hemoptysis and airway compression in a patient with bovine aortic arch

We present the case of a 63-year-old man with a bovine aortic arch variation, who presented episodes of mild hemoptysis secondary to a 4.5-cm (diameter) aneurysm of the innominate artery that compressed the trachea and obliterated the right subclavian artery. Surgery, performed through a median sternotomy, consisted of a bypass from the ascending aorta to both common carotid arteries using a Dacron graft, and exclusion of the aneurysm by ligature and direct thrombin injection. Computed tomography angiography at 30 days showed a patent bypass, successful aneurysm exclusion, and improvement of the tracheal compression. The patient is currently asymptomatic at 12 months following the procedure.

Tuberculous hilar lymph nodes leading to tracheopulmonary artery fistula and pseudoaneurysm of pulmonary artery

Tracheopulmonary artery fistula is an extremely rare condition. We report the case of an 80-year-old man who presented with massive hemoptysis. He was found to have tuberculous mediastinal lymph nodes that had eroded into the pulmonary artery and anterior tracheal wall, leading to a pseudoaneurysm of the right pulmonary artery and a tracheopulmonary artery fistula.