Hybrid surgery for a severe infectious innominate artery pseudoaneurysm compressing the main trachea

• Published in: Journal of international medical research Vol. 48; no. 10; p. 300060520965843
• Main Authors: Lian, Li-Shan, Zhang, Zhe, Feng, Hai, Chen, Xue-Ming
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.10.2020; Sage Publications Ltd; SAGE Publishing
• Subjects: Adult; Aneurysm, False - diagnostic imaging; Aneurysm, False - surgery; Brachiocephalic Trunk - diagnostic imaging; Brachiocephalic Trunk - surgery; Case Report; Humans; Male; Ostomy; Pseudoaneurysm; Stents; Trachea - diagnostic imaging; Trachea - surgery; Treatment Outcome; Veins & arteries; anti-infection therapy; endovascular repair; Infectious innominate pseudoaneurysm; extra-anatomic bypass; hybrid surgery; median thoracotomy; saphenous vein graft patency
• ISSN: 0300-0605; 1473-2300
• DOI: 10.1177/0300060520965843

Here, we report a case of an infectious pseudoaneurysm at the root of the innominate artery, compressing the trachea, that resulted in massive hemorrhage due to rupture of the innominate artery. The patient, a 31-year-old man, had complained of persistent fever for 40 days and severe dyspnea for 1 week. Contrast-enhanced computed tomography imaging of neck and thorax showed a pseudoaneurysm originating from the root of the innominate artery that was severely compressing the main trachea. A hybrid surgery strategy was applied. We first implanted a covered stent in the root of the innominate artery. Then, we performed a left-to-right carotid−carotid bypass with a great saphenous vein graft. Finally, we performed a median thoracotomy in which both the pseudoaneurysm and the previously implanted covered stent were successfully extracted. The patient lost strength in the right upper limb muscle on postoperative day 2 but recovered to baseline strength after 3 months. A hybrid surgical technique may represent a practical solution for such conditions.