Iatrogenic injury of the brachiocephalic arterial trunk and its branches--case report

• Published in: Acta medica Croatica Vol. 60; no. 5; p. 497
• Main Authors: Trajbar, Tomislav, Gverić, Tugomir, Kosuta, Dragutin, Ivkosić, Ante, Pavić, Predrag, Zoricić, Ivan, Adam, Visnja Nesek
• Format: Journal Article
• Language: Croatian
• Published: Croatia 01.12.2006
• Subjects: Blood Vessel Prosthesis Implantation; Brachiocephalic Trunk - injuries; Brachiocephalic Trunk - radiation effects; Brachiocephalic Trunk - surgery; Carotid Artery Injuries - etiology; Carotid Artery, Common; Humans; Intraoperative Complications; Lymph Node Excision; Lymphatic Metastasis; Male; Middle Aged; Neck; Radiation Injuries; Subclavian Artery - injuries; Subclavian Artery - radiation effects; Subclavian Artery - surgery; Thyroid Neoplasms - radiotherapy; Thyroid Neoplasms - surgery
• ISSN: 1330-0164

Iatrogenic vascular traumas are increasing and their proportion exceeds 40% of all vascular injuries. We report on a rare case of iatrogenic injury of the brachiocephalic arterial trunk during surgical intervention due to postirradiation arteriopathy, which was successfully treated with a silver prosthesis graft. A 58-year-old male underwent surgery for metastases of papillary carcinoma of the thyroid gland, located in lymph nodes adjacent to the right common carotid artery and right subclavian artery. During the surgery, there was an intraoperative injury of the brachiocephalic arterial trunk that included spontaneous rupture and tear of the subclavian and common carotid artery, as the result of extreme fragility of the arterial wall, probably due to the previous irradiation therapy. Emergency sternotomy and clavicle resection were followed by blood flow reconstruction by use of an Y prosthesis that was applied for terminoterminal anastomosis between the brachiocephalic trunk to common carotid artery and subclavian artery. The authors concluded that irradiation therapy may lead to progressive arteriopathy in affected arteries.