Endovascular treatment of brachiocephalic artery war-related injury

Management of injuries near the innominate artery bifurcation using an accurate kissing Viabahn stent technique

OBJECTIVE

To evaluate the feasibility, safety, and efficacy of an accurate kissing Viabahn stent technique to manage injuries near the innominate artery bifurcation.

METHODS

This retrospective study included patients with injuries near the innominate artery bifurcation who were treated with an accurate kissing Viabahn stent technique. Perioperative and follow-up data were extracted and analysed.

RESULTS

A total of 10 patients were included (mean age, 52.8 years; six male and four female patients) with injuries at the following sites: the distal end of the innominate artery (n = 2), the innominate artery bifurcation (n = 5), the root of the right common carotid artery (n = 2) and the origin of the right subclavian artery (n = 1). All were successfully treated with the accurate kissing Viabahn stent technique. During follow-up (mean duration, 16.8 months), there were no complications, such as right upper limb ischaemia, neurological dysfunction, stent occlusion or migration.

CONCLUSIONS

The accurate kissing Viabahn stent technique to manage injuries near the bifurcation of the innominate artery was safe and effective, with good perioperative and long-term follow-up results.

Covered Endovascular Repair of Innominate Artery Bifurcation After Thoracic Blunt Trauma

Innominate artery (IA) injury is a rare entity with most patients dying before reaching the hospital. While open surgery remains the standard treatment, the endovascular approach is attractive as it may reduce perioperative morbidity and mortality. We report a case of IA blunt injury extending to the subclavian artery with pseudoaneurysm formation successfully treated with covered stenting of IA and its bifurcation. A 49-year-old male was admitted after suffering multiple trauma due to a high energy impact motorcycle crash. In the emergency room, the patient was hypotensive with a Glasgow coma score of 15. On physical examination, he had right peri-orbital ecchymosis, left otorrhagia and an open patella fracture. The computed tomographic angiography (CTA) revealed enlargement of the mediastinum and a 29 mm pseudoaneurysm involving the right brachiocephalic trunk and its bifurcation. Under general anesthesia, a covered balloon-expandable stent (CBES) was then placed in the IA followed by kissing stent of its bifurcation with an additional 2 covered balloon-expandable stents. Final subtraction angiography demonstrated complete pseudoaneurysm exclusion and stent patency without additional complications. No neurologic deficits or other intervention-related complications were found in the postoperative period. At 10 months follow-up, the patient remained asymptomatic and with palpable distal pulses. Endovascular management of IA injury may provide a good alternative to open surgery with low perioperative morbidity and mortality.