Innominate artery aneurysm with hemoptysis and airway compression in a patient with bovine aortic arch

• Published in: Journal of vascular surgery 2012-09, Vol.56 (3), p.822-825
• Main Authors: Constenla, Iván, MD, Alvarez, Beatriz, MD, PhD, Yugueros, Xavier, MD, Fernandez, Elisabeth, MD, Bofill, Ramon, MD, Matas, Manel, MD, PhD
• Format: Article
• Language: English
• Subjects: Airway Obstruction - diagnosis; Airway Obstruction - etiology; Aneurysm - complications; Aneurysm - diagnosis; Aneurysm - surgery; Aorta, Thoracic - abnormalities; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - surgery; Aortography - methods; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis Implantation; Brachiocephalic Trunk - diagnostic imaging; Brachiocephalic Trunk - surgery; Cardiology. Vascular system; Carotid Artery, Common - abnormalities; Carotid Artery, Common - surgery; Diseases of the aorta; Hemoptysis - diagnosis; Hemoptysis - etiology; Humans; Injections, Intralesional; Ligation; Male; Medical sciences; Middle Aged; Sternotomy; Subclavian Steal Syndrome - etiology; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Thrombin - administration & dosage; Tomography, X-Ray Computed; Tracheal Stenosis - diagnosis; Tracheal Stenosis - etiology; Treatment Outcome; Vascular Malformations - complications; Vascular Malformations - diagnosis; Vascular Malformations - surgery; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2012.03.241

We present the case of a 63-year-old man with a bovine aortic arch variation, who presented episodes of mild hemoptysis secondary to a 4.5-cm (diameter) aneurysm of the innominate artery that compressed the trachea and obliterated the right subclavian artery. Surgery, performed through a median sternotomy, consisted of a bypass from the ascending aorta to both common carotid arteries using a Dacron graft, and exclusion of the aneurysm by ligature and direct thrombin injection. Computed tomography angiography at 30 days showed a patent bypass, successful aneurysm exclusion, and improvement of the tracheal compression. The patient is currently asymptomatic at 12 months following the procedure.