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Journal of Vascular Surgery Aug 2018Atherosclerotic innominate artery occlusive disease can lead to cerebral and upper extremity ischemia. Innominate artery angioplasty and stenting can be complicated by...
Atherosclerotic innominate artery occlusive disease can lead to cerebral and upper extremity ischemia. Innominate artery angioplasty and stenting can be complicated by stent fractures and restenosis; furthermore, this technique is limited in treatment of innominate artery occlusions. Ministernotomy to the second or third intercostal space can be used instead of conventional full sternotomy for open surgical revascularization of the innominate artery with excellent perioperative and long-term outcomes. This series of three consecutive patients highlights the technique of aorta-innominate artery bypass through ministernotomy.
Topics: Aged; Aorta; Blood Vessel Prosthesis Implantation; Brachiocephalic Trunk; Female; Humans; Middle Aged; Peripheral Arterial Disease; Retrospective Studies; Sternotomy; Suture Techniques; Treatment Outcome
PubMed: 30037677
DOI: 10.1016/j.jvs.2018.01.069 -
BMC Surgery Feb 2022Surgery to prevent aspiration has complications related to tracheostomy tube, such as the trachea-brachiocephalic artery fistula. Glottic closure procedure makes...
BACKGROUND
Surgery to prevent aspiration has complications related to tracheostomy tube, such as the trachea-brachiocephalic artery fistula. Glottic closure procedure makes tracheostoma at a position higher than the first ring of the trachea and theoretically has a potential to prevent such complications owing to a longer distance between the tip of tracheostomy tube and the tracheal membrane adjacent to the brachiocephalic artery. Our aim is to evaluate the safety of glottic closure in neurologically impaired patients by comparing outcomes with laryngotracheal separation.
METHODS
This study is a single-center retrospective study from 2004 to 2019, using data of 15 and 12 patients who underwent glottic closure (GC) and laryngotracheal separation (LTS). The primary outcome was the incidence of postoperative complications induced by tracheostomy tube placement and adjustment of the tracheostomy tube position to prevent these complications, such as by converting to a length-adjustable tube and/or placing gauze between the skin and tube flange. Additionally, we analyzed the anatomical relationship between the tracheostomy tube tip and brachiocephalic artery and measured the distance between them using postoperative CT images.
RESULTS
No patients in either group had trachea-brachiocephalic artery fistula. Erosion or granuloma formation occurred in 1 patient (7%) and 4 patients (33%) in the GC and LTS groups, respectively. Adjustment of the tracheostomy tube was needed in 2 patients (13%) and 6 patients (50%) in the GC and LTS groups. CT revealed a higher proportion of patients with the tracheostomy tube tip superior to the brachiocephalic artery in GC than LTS group. The mean tracheostoma-brachiocephalic artery distance was 40.8 and 32.4 mm in the GC and LTS groups.
CONCLUSIONS
Glottic closure reduces the risk of postoperative complications related to a tracheostomy tube. This may be due to the higher position of the tracheostoma at the level of the cricoid cartilage, increasing the distance between the tracheostoma and brachiocephalic artery.
Topics: Brachiocephalic Trunk; Humans; Postoperative Complications; Retrospective Studies; Trachea; Tracheostomy
PubMed: 35148723
DOI: 10.1186/s12893-022-01505-2 -
Journal of Vascular Surgery Jul 2018The aortic arch (AA) is the main conduit of the left side of the heart, providing a blood supply to the head, neck, and upper limbs. As it travels through the thorax,... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The aortic arch (AA) is the main conduit of the left side of the heart, providing a blood supply to the head, neck, and upper limbs. As it travels through the thorax, the pattern in which it gives off the branches to supply these structures can vary. Variations of these branching patterns have been studied; however, a study providing a comprehensive incidence of these variations has not yet been conducted. The objective of this study was to perform a meta-analysis of all the studies that report prevalence data on AA variants and to provide incidence data on the most common variants.
METHODS
A systematic search of online databases including PubMed, Embase, Scopus, ScienceDirect, Web of Science, SciELO, BIOSIS, and CNKI was performed for literature describing incidence of AA variations in adults. Studies including prevalence data on adult patients or cadavers were collected and their data analyzed.
RESULTS
A total of 51 articles were included (N = 23,882 arches). Seven of the most common variants were analyzed. The most common variants found included the classic branching pattern, defined as a brachiocephalic trunk, a left common carotid, and a left subclavian artery (80.9%); the bovine arch variant (13.6%); and the left vertebral artery variant (2.8%). Compared by geographic data, bovine arch variants were noted to have a prevalence as high as 26.8% in African populations.
CONCLUSIONS
Although patients who have an AA variant are often asymptomatic, they compose a significant portion of the population of patients and pose a greater risk of hemorrhage and ischemia during surgery in the thorax. Because of the possibility of encountering such variants, it is prudent for surgeons to consider potential variations in planning procedures, especially of an endovascular nature, in the thorax.
Topics: Aneurysm; Aorta, Thoracic; Black People; Brachiocephalic Trunk; Cardiovascular Abnormalities; Carotid Arteries; Humans; Incidence; Prevalence; Prognosis; Subclavian Artery; Vertebral Artery
PubMed: 28865978
DOI: 10.1016/j.jvs.2017.06.097 -
Brazilian Journal of Cardiovascular... Apr 2023The aim of this study was to evaluate the efficacy and safety of innominate artery cannulation strategy with side-graft technique in proximal aortic pathologies.
INTRODUCTION
The aim of this study was to evaluate the efficacy and safety of innominate artery cannulation strategy with side-graft technique in proximal aortic pathologies.
METHODS
A total of 70 patients underwent innominate artery cannulation with a side graft for surgery on the proximal aorta from 2012 to 2020. There were 46 men and 24 women with an average age of 56±13 years. The indications for surgery were type A aortic dissection in 17 patients (24.3%), aortic aneurysm in 52 patients (74.3%), and ascending aorta pseudoaneurysm in one patient (1.4%). The innominate artery was free of disease in all patients. Hypothermic circulatory arrest with antegrade cerebral perfusion was utilized in 60 patients (85.7%). Three patients had previous sternotomy (4.2%). The most common surgical procedure was ascending aorta with hemiarch replacement in 34 patients (48.5%).
RESULTS
The mean cardiac ischemia and cardiopulmonary bypass times were 116+46 minutes and 164+56 minutes, respectively. Mean antegrade cerebral perfusion time was 27+14 minutes. The patients were cooled between 22°C and 30°C during surgery. Thirty-day mortality rate was 7.1% (five patients). One patient (1.4%) had stroke, one patient (1.4%) had temporary neurologic deficit, and eight patients (11.4%) had confusion and agitation that resolved completely in all cases. There was no local complication or arterial injury.
CONCLUSION
Cannulation of the innominate artery with side graft is safe and effective for both cardiopulmonary bypass and antegrade cerebral perfusion. This technique provides satisfactory neurologic outcomes for proximal aortic surgery.
Topics: Male; Humans; Female; Adult; Middle Aged; Aged; Brachiocephalic Trunk; Cerebrovascular Circulation; Catheterization; Aorta; Aortic Dissection; Cardiopulmonary Bypass; Treatment Outcome; Aorta, Thoracic
PubMed: 36260000
DOI: 10.21470/1678-9741-2022-0045 -
Revista Paulista de Pediatria : Orgao... 2021Tracheoinnominate fistula (TIF) is a rare and frequently lethal complication of tracheostomies. Immediate bleeding control and surgical treatment are essential to avoid...
OBJECTIVE
Tracheoinnominate fistula (TIF) is a rare and frequently lethal complication of tracheostomies. Immediate bleeding control and surgical treatment are essential to avoid death. This report describes the successful endovascular treatment of TIF in a preschooler and reviews the literature concerning epidemiology, diagnosis, prophylaxis, and treatment of TIF in pediatric patients.
CASE DESCRIPTION
A tracheostomized neurologically impaired bed-ridden three-year-old girl was admitted to treat an episode of tracheitis. Tracheostomy had been performed two years before. The child used a plastic cuffed tube continually inflated at low pressure. The patient presented two self-limited bleeding episodes through the tracheostomy in a 48h interval. A new episode was suggestive of arterial bleeding, immediately leading to a provisional diagnosis of TIF, which was confirmed by angiotomography, affecting the bifurcation of the innominate artery and the right tracheal wall. The patient was immediately treated by the endovascular placement of polytetrafluoroethylene (PTFE)/nitinol stents in Y configuration. No recurrent TIF, neurological problems, or right arm ischemia have been detected in the follow-up.
COMMENTS
TIF must be suspected after any significant bleeding from the tracheostoma. Endovascular techniques may provide rapid bleeding control with low morbidity, but they are limited to a few case reports in pediatric patients, all of them addressing adolescents. Long-term follow-up is needed to detect whether stent-related vascular complications will occur with growth.
Topics: Brachiocephalic Trunk; Child, Preschool; Female; Hemorrhage; Humans; Respiratory Tract Fistula; Tracheostomy; Zika Virus Infection
PubMed: 34259783
DOI: 10.1590/1984-0462/2022/40/2020229 -
Chinese Journal of Traumatology =... Feb 2020To discuss and share the experience of treatment of traumatic innominate arterial injury.
PURPOSE
To discuss and share the experience of treatment of traumatic innominate arterial injury.
METHODS
A retrospective analysis was performed on patients with innominate arterial injuries admitted from January 2016 to July 2018 at the department of vascular surgery, Beijing Jishuitan Hospital, China. All the arterial injuries were confirmed by arteriography. Clinical data including mechanism of injury, type of injury, demographics, concomitant injuries, time interval from trauma to blood flow reconstruction, and operation methods were collected. Follow-up program included outpatient visit and duplex-ultrasonography. SPSS version 23.0 was adopted for data analysis. Categorical variables are presented as number and/or frequency and continuous variables as mean ± standard deviation.
RESULT
Altogether 7 patients were included and 6 (85.7%) were male. The mean age of patients was (29.43 ± 7.98) years, range 19-43 years. Six patients had isolated innominate arterial injuries and the rest 1 combined innominate arterial and vein injuries. The injury causes were road accidents in 3 patients, stab wound in 2, gunshot wound in 1, and crush injury in 1. All the 7 patients presented hemorrhagic shock at admission, which was timely and effectively corrected. No perioperative death or technical complications occurred. Intimal injury (n = 2) and partial transaction (n = 2) of the innominate artery were treated with covered stents. Two patients with complete transection of artery received vascular reconstruction by artificial grafts. One patient with partial transaction received balloon dilation and open surgical repair (hybrid operation). The mean time interval from trauma to blood flow reconstruction was (4.27 ± 0.18) h, range 4.0-4.5 h; while the operation time was (48.57 ± 19.94) min, range 25-75 min. Cerebral infarction occurred in one patient with brain injury due to anticoagulation contraindication. The average follow-up was (13.29 ± 5.65) months, range 6-24 months. No severe stenosis, occlusion, and thrombosis of covered stents or artificial vessels were found by color Doppler ultrasound.
CONCLUSION
Urgent control of hemorrhage and restoration of blood supply are critical for the treatment of traumatic innominate arterial injury. Endovascular therapy is a feasible and effective method with short operation time and less trauma.
Topics: Adult; Angiography; Brachiocephalic Trunk; Endovascular Procedures; Feasibility Studies; Female; Follow-Up Studies; Hemorrhage; Humans; Male; Operative Time; Rupture; Time Factors; Young Adult
PubMed: 31992478
DOI: 10.1016/j.cjtee.2019.11.004 -
The Annals of Thoracic Surgery Jul 2009
Topics: Anastomosis, Surgical; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Brachiocephalic Trunk; Female; Humans; Male; Prognosis; Radiography; Risk Assessment; Spinal Cord Ischemia; Survival Analysis
PubMed: 19559182
DOI: 10.1016/j.athoracsur.2009.04.090 -
Arteriosclerosis, Thrombosis, and... Apr 2015The purpose of this study was to determine the role of the endothelial glucocorticoid receptor in the pathogenesis of atherosclerosis.
OBJECTIVE
The purpose of this study was to determine the role of the endothelial glucocorticoid receptor in the pathogenesis of atherosclerosis.
APPROACH AND RESULTS
Control mice and mice lacking the endothelial glucocorticoid receptor were bred onto an Apoe knockout background and subjected to high-fat diet feeding for 12 weeks. Assessment of body weight and total cholesterol and triglycerides before and after the diet revealed no differences between the 2 groups of mice. However, mice lacking the endothelial glucocorticoid receptor developed more severe atherosclerotic lesions in the aorta, brachiocephalic artery, and aortic sinus, as well as a heightened inflammatory milieu as evidenced by increased macrophage recruitment in the lesions.
CONCLUSIONS
These data suggest that the endothelial glucocorticoid receptor is important for tonic inhibition of inflammation and limitation of atherosclerosis progression in this model.
Topics: Animals; Aorta; Aortic Diseases; Apolipoproteins E; Atherosclerosis; Body Weight; Brachiocephalic Trunk; Cholesterol; Diet, High-Fat; Disease Models, Animal; Endothelial Cells; Genotype; Macrophages; Mice, Inbred C57BL; Mice, Knockout; Phenotype; Receptors, Glucocorticoid; Severity of Illness Index; Time Factors; Triglycerides
PubMed: 25810297
DOI: 10.1161/ATVBAHA.114.304525 -
Antioxidants (Basel, Switzerland) Oct 2022This study investigated the efficacy of aerobic exercise training (AET) in the prevention of dyslipidemia, insulin resistance (IR), and atherogenesis induced by severe...
This study investigated the efficacy of aerobic exercise training (AET) in the prevention of dyslipidemia, insulin resistance (IR), and atherogenesis induced by severe low-sodium (LS) diet. LDL receptor knockout (LDLR KO) mice were fed a low-sodium (LS) (0.15% NaCl) or normal-sodium (NS; 1.27% NaCl) diet, submitted to AET in a treadmill, 5 times/week, 60 min/day, 15 m/min, for 90 days, or kept sedentary. Blood pressure (BP), plasma total cholesterol (TC) and triglyceride (TG) concentrations, lipoprotein profile, and insulin sensitivity were evaluated at the end of the AET protocol. Lipid infiltration, angiotensin II type 1 receptor (AT1), receptor for advanced glycation end products (RAGE), carboxymethyllysine (CML), and 4-hydroxynonenal (4-HNE) contents as well as gene expression were determined in the brachiocephalic trunk. BP and TC and gene expression were similar among groups. Compared to the NS diet, the LS diet increased vascular lipid infiltration, CML, RAGE, 4-HNE, plasma TG, LDL-cholesterol, and VLDL-TG. Conversely, the LS diet reduced vascular AT1 receptor, insulin sensitivity, HDL-cholesterol, and HDL-TG. AET prevented arterial lipid infiltration; increases in CML, RAGE, and 4-HNE contents; and reduced AT1 levels and improved LS-induced peripheral IR. The current study showed that AET counteracted the deleterious effects of chronic LS diet in an atherogenesis-prone model by ameliorating peripheral IR, lipid infiltration, CML, RAGE, 4-HNE, and AT1 receptor in the intima-media of the brachiocephalic trunk. These events occurred independently of the amelioration of plasma-lipid profile, which was negatively affected by the severe dietary-sodium restriction.
PubMed: 36290746
DOI: 10.3390/antiox11102023 -
Journal of Vascular Surgery Feb 2018The objective of this study was to describe in the general population the anatomy of the supra-aortic trunks (SATs: brachiocephalic trunk [BCT], left common carotid...
OBJECTIVE
The objective of this study was to describe in the general population the anatomy of the supra-aortic trunks (SATs: brachiocephalic trunk [BCT], left common carotid artery [LCCA], and left subclavian artery [LSA]) arising from the aortic arch in terms of mutual distances from the valvular aortic plane (VAP), ostial diameters, and clock face orientation from the sagittal aortic axis, with an analysis of each distribution.
METHODS
Measurements of 252 computed tomography angiograms of the aortic arch and SATs in three groups of patients (84 without any disease of the aortic arch, group A; 84 with dilation of the aortic arch, group B; 84 with dilation of the descending thoracic aorta below the LSA, group C) were retrospectively collected and analyzed. The Shapiro-Wilk test was used to assess normality of each distribution.
RESULTS
The ostial diameters of the SATs followed a gaussian distribution in all groups. In group A, only VAP-BCT and LCCA-LSA distances were normal, being in 95% of cases between 46.6 and 88.2 mm and between 8 and 23.3 mm, respectively. In both groups B and C, the distance VAP-BCT and the takeoff angle of both LCCA and LSA were gaussian distributed (being in 95% of cases between 48.5 and 102.1 mm, -17.6° and 33°, and -17.7° and 23.4°, respectively, in group B; and between 51.3 and 101.1 mm, -28.2° and 33.7°, and -28.7° and 31.3°, respectively, in group C). VAP-BCT distance and BCT angle were lower in group A compared with group B (P < .001 and P = .008, respectively) and group C (P < .001 and P = .04, respectively). Irrespective of the group, all SAT mutual distances and ostial diameters were related to the aortic diameters, being greater for increasing aortic diameters. Neither BCT angle nor LSA angle was related to the aortic diameters, whereas LCCA angle was inversely correlated.
CONCLUSIONS
Most of the analyzed variables did not show a gaussian distribution, both in healthy and in diseased patients. Irrespective of the group, all SAT mutual distances and ostial diameters were related to the aortic diameters, being greater for increasing aortic diameters.
Topics: Aged; Anatomic Landmarks; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Aortic Valve; Aortography; Brachiocephalic Trunk; Carotid Artery, Common; Computed Tomography Angiography; Dilatation, Pathologic; Female; Humans; Male; Middle Aged; Normal Distribution; Predictive Value of Tests; Radiographic Image Interpretation, Computer-Assisted; Reproducibility of Results; Retrospective Studies; Subclavian Artery
PubMed: 28830708
DOI: 10.1016/j.jvs.2017.04.076