Spontaneous innominate and left common carotid artery dissection with bovine aortic arch

We describe a case of a 63-year-old woman who presented with spontaneous dissection of the innominate and left common carotid arteries arising from a common trunk, so-called “bovine aortic arch.” The entry tear was seen in the common trunk at the origin of the innominate artery with no dissection extending into the aortic arch or the ascending aorta. The dissection was resected and total arch replacement was performed considering the aortic wall fragility complicated by the dissection.     

Blunt injury of the innominate artery and left innominate vein

Injuries to the branches of the aortic arch are rare and may be caused by blunt, penetrating, blast or iatrogenic trauma. Innominate vascular injury is a rare entity, particularly in blunt trauma. It is estimated that 71% of patients with innominate injuries die before arrival at the hospital. We report here a successfully managed case of a combined blunt trauma of the innominate artery and transection of the left innominate vein after blunt injury to the chest.     

Combined endovascular and open repair of a penetrating innominate artery and tracheal injury

Endovascular therapy affords the opportunity to decrease surgical morbidity and improve operative planning in complex penetrating injuries of the chest. In this case report we describe a hemodynamically stable patient with a single gunshot wound to the base of the neck (zone I), with combined vascular and tracheal injuries. We present a novel approach to the repair of this type of injury using combined endovascular and open techniques.     

Combined carotid endarterectomy, innominate artery reconstruction, and coronary artery bypass grafting: Case report

Neurologic injury is one of the most devastating complications of combined carotid and cardiac procedures. Although the cause of the deficit is usually embolic, the exact cause is often not apparent at the time of surgery. We present a complex case of combined carotid endarterectomy, innominate artery reconstruction, and coronary artery bypass procedures in which intraoperative monitoring with somatosensory evoked potentials and transcranial Doppler ultrasonography combined with postoperative acetazolamide single photon emission computed tomographic scans was used to correlate intraoperative events with cerebral activity and functional results. Although computed tomographic scan, magnetic resonance imaging, and clinical evaluation were negative for any evidence of stroke, the patient exhibited subtle postoperative changes in neuropsychologic function. These changes were correlated with intraoperative microemboli detected by transcranial Doppler monitoring, and postoperative acetazolamide single photon emission computed tomographic scanning, which revealed bilateral cortical defects. (J Vasc Surg 1996;24;1017-21.)     

Combined traumatic avulsion of the aortic valve and rupture of the left common carotid artery.

A case of complete rupture of the left common carotid artery at the aortic arch and avulsion of a cusp of the aortic valve due to blunt trauma is presented. The ruptured carotid artery was reimplanted into the left subclavian artery, and the avulsed aortic valve cusp was successfully repaired by direct suturing.     

Agenesis of the left internal carotid artery, common carotid artery, and main trunk of the external carotid artery associated with multiple cerebral aneurysms

A case of agenesis of the left internal carotid artery, common carotid artery, and the main trunk of the external carotid artery with multiple cerebral aneurysms is presented. This case was diagnosed by angiography and computed tomography scanning and confirmed by operation. Correlation between the anomaly of the circle of Willis based on the absence of the internal carotid artery and the development of cerebral aneurysm is discussed on the basis of the reported cases.     

Separate arch origin of the left external carotid artery with common trunk giving rise to the left internal carotid artery and left subclavian artery

We present a case of a 3-year-old boy with tetralogy of Fallot having the direct origin of the left external carotid artery from the aorta with a common trunk giving rise to the left internal carotid artery and left subclavian artery, in a right-sided aortic arch. We also highlight the potential implications in management.     

Complications associated with clamping the aorta between the left common carotid artery and left subclavian artery

BACKGROUND: Hypothermic circulatory arrest using a left thoracotomy has recently been recommended for repair of distal arch lesions to prevent the atheroembolism that often results from clamp injury. The recommendation holds even for cases in which aortic cross-clamping between the left common carotid artery and left subclavian artery is possible. METHODS: Over the last 16 years, 69 patients underwent repair of the distal arch or descending thoracic aorta using distal perfusion with the proximal aortic clamp placed between the left common carotid and left subclavian artery. The average age of the patients was 61+/-12 years; 18 of them (26%) were older than 70 years. Forty-four patients (64%) had atherosclerotic true aneurysms. RESULTS: The surgical procedures used included patch closure of saccular aneurysms in 20 patients (29%) and graft replacement in 47 (71%). The left subclavian artery was reattached in 7 patients (10%). Although there were 3 hospital deaths (4%), no cerebral complications occurred aside from temporary neurologic dysfunction in 4 patients (6%). CONCLUSIONS: An acceptably low incidence of cerebral complications is associated with cross-clamping the aorta between the left common carotid artery and left subclavian artery.     

Hematemesis due to fistula between aorta and esophagus and later to fistula between left common carotid artery and esophagus. Case report

A case of massive hematemesis due to an aortoesophageal fistula is presented. The diagnosis was made intraoperatively. The patient died 39 days postoperatively of an additional, previously unidentified fistula between the left common carotid artery and the esophagus. This fistula combination does not seem to have been reported previously.