PDF(Pubmed)
Abstract：
BACKGROUND: Innominate artery aneurysms (IAAs) are rare and may result in rupture, distal arterial embolization, or local compression without timely treatment. Rupture is the most dangerous of these complications. This article reports a case of innominate artery bifurcation pseudoaneurysm.
METHODS: The patient was a 45-year-old man who was admitted to the emergency department due to chest discomfort. The computed tomographic angiography (CTA) imaging indicated the presence of a 3.6*2.4 cm saccular aneurysm in the bifurcation of the innominate artery, involving both the right proximal subclavian and common carotid arteries. The patient\'s vital signs were normal, there was equal blood pressure in the upper arms and no neurological dysfunction was observed. Gadolinium-enhanced magnetic resonance angiography indicated that the circle of Willis was intact. The treatment involved open surgery combined with endovascular therapy. The external carotid artery was first transposed to the right subclavian artery (RSA) and an 8-mm woven Dacron graft was inserted in the middle. The covered stent graft was then placed in the proximal part of the innominate artery to close the entrance of the aneurysm. Lastly, an occluder was implanted at the origin of the RSA. There were no perioperative or postoperative complications. At 1-year follow-up, no aneurysm was observed on CTA and the right vertebral artery was patent.
CONCLUSIONS: This study indicated that the combined use of endovascular therapy and open repair surgery is an effective strategy to treat innominate artery bifurcation pseudoaneurysm.
METHODS: The patient was a 45-year-old man who was admitted to the emergency department due to chest discomfort. The computed tomographic angiography (CTA) imaging indicated the presence of a 3.6*2.4 cm saccular aneurysm in the bifurcation of the innominate artery, involving both the right proximal subclavian and common carotid arteries. The patient\'s vital signs were normal, there was equal blood pressure in the upper arms and no neurological dysfunction was observed. Gadolinium-enhanced magnetic resonance angiography indicated that the circle of Willis was intact. The treatment involved open surgery combined with endovascular therapy. The external carotid artery was first transposed to the right subclavian artery (RSA) and an 8-mm woven Dacron graft was inserted in the middle. The covered stent graft was then placed in the proximal part of the innominate artery to close the entrance of the aneurysm. Lastly, an occluder was implanted at the origin of the RSA. There were no perioperative or postoperative complications. At 1-year follow-up, no aneurysm was observed on CTA and the right vertebral artery was patent.
CONCLUSIONS: This study indicated that the combined use of endovascular therapy and open repair surgery is an effective strategy to treat innominate artery bifurcation pseudoaneurysm.
摘要：
背景：无名动脉瘤（IAAs）很少见，可能会导致破裂，远端动脉栓塞,或局部压迫不及时治疗。破裂是这些并发症中最危险的。本文报告1例无名动脉分叉假性动脉瘤。
方法：患者是一名45岁的男性，因胸部不适而进入急诊科。CT血管造影（CTA）显示无名动脉分叉处存在3.6*2.4cm囊状动脉瘤，涉及右锁骨下动脉和颈总动脉。病人的生命体征正常,上臂血压相等,未观察到神经功能障碍.钆增强磁共振血管造影显示Willis环是完整的。治疗包括开放手术结合血管内治疗。首先将颈外动脉转移到右锁骨下动脉（RSA），并在中间插入8毫米编织的涤纶移植物。然后将覆盖的支架移植物放置在无名动脉的近端部分以封闭动脉瘤的入口。最后,在RSA的起源植入了封堵器。无围手术期及术后并发症。在1年的随访中，在CTA上未观察到动脉瘤,右侧椎动脉通畅.
结论：本研究表明，联合使用血管内治疗和开放修复手术是治疗无名动脉分叉假性动脉瘤的有效策略。
方法：患者是一名45岁的男性，因胸部不适而进入急诊科。CT血管造影（CTA）显示无名动脉分叉处存在3.6*2.4cm囊状动脉瘤，涉及右锁骨下动脉和颈总动脉。病人的生命体征正常,上臂血压相等,未观察到神经功能障碍.钆增强磁共振血管造影显示Willis环是完整的。治疗包括开放手术结合血管内治疗。首先将颈外动脉转移到右锁骨下动脉（RSA），并在中间插入8毫米编织的涤纶移植物。然后将覆盖的支架移植物放置在无名动脉的近端部分以封闭动脉瘤的入口。最后,在RSA的起源植入了封堵器。无围手术期及术后并发症。在1年的随访中，在CTA上未观察到动脉瘤,右侧椎动脉通畅.
结论：本研究表明，联合使用血管内治疗和开放修复手术是治疗无名动脉分叉假性动脉瘤的有效策略。
