Ligation of Innominate Artery and Axillo-axillary Crossover Bypass for Innominate Artery Stenosis with Irregular Atheroma
An 84-year-old man developed right cerebral infarction recently twice a year. Enhanced computed tomography revealed innominate artery stenosis with irregular atheroma and diameter of innominate artery was expanded to 17 mm. The atheroma was considered to be the cause of cerebral infarction, and the...
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| Published in | Japanese Journal of Vascular Surgery Vol. 29; no. 4; pp. 193 - 196 |
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| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
JAPANESE SOCIETY FOR VASCULAR SURGERY
10.07.2020
特定非営利活動法人 日本血管外科学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0918-6778 1881-767X |
| DOI | 10.11401/jsvs.20-00028 |
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| Abstract | An 84-year-old man developed right cerebral infarction recently twice a year. Enhanced computed tomography revealed innominate artery stenosis with irregular atheroma and diameter of innominate artery was expanded to 17 mm. The atheroma was considered to be the cause of cerebral infarction, and the patient was referred to our hospital for treatment. Endovascular therapy was thougut to be inadequate due to vascular diameter and the difficulty of brain protection. The operation was performed by direct ligation of innominate artery and revascularization by axillo-axillary artery crossover bypass. The postoperative course was uneventful, and the patient was discharged on 6th postoprerative day. One year after the operation, no new symptoms have been observed. The ligation of innominate artery and axillo-axillary artery crossover bypass were effective and less invasive strategy for innominate artery stenosis with irregular atheroma. |
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| AbstractList | An 84-year-old man developed right cerebral infarction recently twice a year. Enhanced computed tomography revealed innominate artery stenosis with irregular atheroma and diameter of innominate artery was expanded to 17 mm. The atheroma was considered to be the cause of cerebral infarction, and the patient was referred to our hospital for treatment. Endovascular therapy was thougut to be inadequate due to vascular diameter and the difficulty of brain protection. The operation was performed by direct ligation of innominate artery and revascularization by axillo-axillary artery crossover bypass. The postoperative course was uneventful, and the patient was discharged on 6th postoprerative day. One year after the operation, no new symptoms have been observed. The ligation of innominate artery and axillo-axillary artery crossover bypass were effective and less invasive strategy for innominate artery stenosis with irregular atheroma. An 84-year-old man developed right cerebral infarction recently twice a year. Enhanced computed tomography revealed innominate artery stenosis with irregular atheroma and diameter of innominate artery was expanded to 17 mm. The atheroma was considered to be the cause of cerebral infarction, and the patient was referred to our hospital for treatment. Endovascular therapy was thougut to be inadequate due to vascular diameter and the difficulty of brain protection. The operation was performed by direct ligation of innominate artery and revascularization by axillo-axillary artery crossover bypass. The postoperative course was uneventful, and the patient was discharged on 6th postoprerative day. One year after the operation, no new symptoms have been observed. The ligation of innominate artery and axillo-axillary artery crossover bypass were effective and less invasive strategy for innominate artery stenosis with irregular atheroma. 症例は84歳，男性．1年間に2度の右大脳半球の脳梗塞を発症した．CTにて，不整な粥腫により内腔が狭窄し，径が17 mm大に拡大した腕頭動脈を認めた．遊離粥腫による塞栓が脳梗塞の原因と考えられた．血管径が拡大し，脳保護が難しいことから血管内治療は不適と判断した．手術は直視下で腕頭動脈を結紮し，腋窩–腋窩動脈交叉バイパス術で血行再建を実施した．術後経過は良好で，脳合併症は認められず，第6病日に退院した．腕頭動脈病変が原因と診断された脳虚血疾患に対して本法は低侵襲かつ有効な方法と考えられた． |
| Author | Hayashida, Tomohiro Kato, Gentaro Shichijo, Takeshi Ogawa, Tatsuya Yamamoto, Shu |
| Author_FL | 林田 智博 山本 修 七条 健 加藤 源太郎 小川 達也 |
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| Author_xml | – sequence: 1 fullname: Shichijo, Takeshi organization: Department of Cardiovascular Surgery, Kagawa Prefectural Central Hospital – sequence: 1 fullname: Kato, Gentaro organization: Department of Cardiovascular Surgery, Kagawa Prefectural Central Hospital – sequence: 1 fullname: Hayashida, Tomohiro organization: Department of Cardiovascular Surgery, Kagawa Prefectural Central Hospital – sequence: 1 fullname: Ogawa, Tatsuya organization: Department of Cardiovascular Surgery, Kagawa Prefectural Central Hospital – sequence: 1 fullname: Yamamoto, Shu organization: Department of Cardiovascular Surgery, Kagawa Prefectural Central Hospital |
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| DocumentTitle_FL | 不整な粥腫を有する腕頭動脈狭窄に対し腕頭動脈結紮術，腋窩–腋窩動脈交叉バイパス術を行った1例 |
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| References | 5) Nakajima M, Yasaka M, Minematsu K. Mobile thrombus from a ruptured plaque in the brachiocephalic artery. J Stroke Cerebrovasc Dis 2008; 17: 423–425. 3) Bradaric C, Kuhs K, Groha P, et al. Endovascular therapy for steno-occlusive subclavian and innominate artery disease. Circ J 2015; 79: 537–543. 4) Ikenouchi H, Washida K, Yoshimoto T, et al. Balloon-like mobile plaque in the innominate artery: ultrasonographic and pathological perspectives of repetitive embolism. J Stroke Cerebrovasc Dis 2019; 28: e95–e97. 10) Shiiya N, Kunihara T, Kamikubo Y, et al. Isolation technique for stroke prevention in patients with a mobile atheroma. Ann Thorac Surg 2001; 72: 1401–1402. 2) Shadman R, Criqui MH, Bundens WP, et al. Subclavian artery stenosis: prevalence, risk factors, and association with cardiovascular diseases. J Am Coll Cardiol 2004; 44: 618–623. 7) Oishi Y, Hirahara N, Takaseya T, et al. Graft replacement for massive mobile embolic source in brachiocephalic artery. Asian Cardiovasc Thorac Ann 2008; 16: E58–E59. 1) Berguer R, Morasch MD, Kline RA. Transthoracic repair of innominate and common carotid artery disease: immediate and long-term outcome for 100 consecutive surgical reconstructions. J Vasc Surg 1998; 27: 34–41; discussion, 42. 9) Aboyans V, Ricco J, Bartelink M, et al.; ESC Scientific Document Group. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery. Eur Heart J 2018; 39: 763–816. 6) Watari M, Nakajima M, Nishitomi-izumida M, et al. Dynamic migration of a mobile plaque from the brachiocephalic artery detected by ultrasonography. Echocardiography 2013; 30: e28–e29. 8) Paukovits TM, Lukacs L, Berczi V, et al. Percutaneous endovascular treatment of innominate artery lesions: a single-centre experience on 77 lesions. Eur J Vasc Endovasc Surg 2010; 40: 35–43. |
| References_xml | – reference: 4) Ikenouchi H, Washida K, Yoshimoto T, et al. Balloon-like mobile plaque in the innominate artery: ultrasonographic and pathological perspectives of repetitive embolism. J Stroke Cerebrovasc Dis 2019; 28: e95–e97. – reference: 2) Shadman R, Criqui MH, Bundens WP, et al. Subclavian artery stenosis: prevalence, risk factors, and association with cardiovascular diseases. J Am Coll Cardiol 2004; 44: 618–623. – reference: 10) Shiiya N, Kunihara T, Kamikubo Y, et al. Isolation technique for stroke prevention in patients with a mobile atheroma. Ann Thorac Surg 2001; 72: 1401–1402. – reference: 7) Oishi Y, Hirahara N, Takaseya T, et al. Graft replacement for massive mobile embolic source in brachiocephalic artery. Asian Cardiovasc Thorac Ann 2008; 16: E58–E59. – reference: 5) Nakajima M, Yasaka M, Minematsu K. Mobile thrombus from a ruptured plaque in the brachiocephalic artery. J Stroke Cerebrovasc Dis 2008; 17: 423–425. – reference: 6) Watari M, Nakajima M, Nishitomi-izumida M, et al. Dynamic migration of a mobile plaque from the brachiocephalic artery detected by ultrasonography. Echocardiography 2013; 30: e28–e29. – reference: 3) Bradaric C, Kuhs K, Groha P, et al. Endovascular therapy for steno-occlusive subclavian and innominate artery disease. Circ J 2015; 79: 537–543. – reference: 9) Aboyans V, Ricco J, Bartelink M, et al.; ESC Scientific Document Group. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery. Eur Heart J 2018; 39: 763–816. – reference: 1) Berguer R, Morasch MD, Kline RA. Transthoracic repair of innominate and common carotid artery disease: immediate and long-term outcome for 100 consecutive surgical reconstructions. J Vasc Surg 1998; 27: 34–41; discussion, 42. – reference: 8) Paukovits TM, Lukacs L, Berczi V, et al. Percutaneous endovascular treatment of innominate artery lesions: a single-centre experience on 77 lesions. Eur J Vasc Endovasc Surg 2010; 40: 35–43. |
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| SubjectTerms | arteriosclerosis obliterans axillary artery bypass innominate artery stenosis stroke 脳梗塞 腋窩動脈バイパス術 腕頭動脈狭窄 閉塞性動脈硬化症 |
| Title | Ligation of Innominate Artery and Axillo-axillary Crossover Bypass for Innominate Artery Stenosis with Irregular Atheroma |
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