Endovascular Repair of a Traumatic Innominate Artery Aneurysm

A previously healthy 20-year-old male was admitted to the emergency department following a head-on car collision. He was a front-seat passenger wearing a seatbelt. The driver of the patient’s car survived; however, the five occupants of the other car were killed on impact. This indicates the force and mechanism of the collision. The patient sustained multiple injuries, including right flail chest and bilateral haemopneumothorax. CT scan showed an extensive mediastinal haematoma. Fig. 1. Angiogram demonstrating innominate artery aneurysm. Thoracic angiography identified a small tear and pseudoaneurysm (2.4 cm diameter) in the innominate artery about 0.5 cm from its origin (Fig. 1). There was The aneurysm was repaired under general anaesthetic using an endovascular approach via the normal filling of the right subclavian and common carotid arteries. As the patient was cardiovascularly right common carotid artery. This was surgically exposed, the patient heparinised (5000 U) and the artery stable and the arterial tear was not leaking it was managed conservatively initially and followed up with clamped. Transcranial Doppler (TCD) monitoring showed an adequate collateral blood flow to the CT scans. The patient was discharged home after six weeks. Two months later CT scans showed the ipsilateral cerebral hemisphere. A vertical arteriotomy was made. A piece of 8 mm pseudoaneurysm had not changed in size and did not involve the aorta. PTFE (Bard, Crawley, U.K.) was pre-stretched by a