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At least 19 recordsLinked to original sources
PubMed1986

[Percutaneous transluminal angioplasty in atheromatous stenosis of the proximal supra-aortic trunks: the brachiocephalic trunk and the subclavian artery].

The authors are reporting their experience about percutaneous transluminal angioplasty (PTA) in atheromatous stenosis of proximal supra-aortic arteries. In this series of 17 patients, with a 6-month follow-up, vertigos were the main clinical symptoms (8 cases), and it must be pointed out that 5 of these 8 patients also underwent a proximal angioplasty of one or the two of their vertebral arteries at the same time. Three subclavian steal-syndromes, one arterial insufficiency of an upper limb, one transient cerebral ischaemia, and four asymptomatic cases were also treated by the same procedure. For diagnosis as well as for follow-up, the authors are emphasizing the value of hemodynamic results of Doppler recording. As for the technics itself, it mainly derives from the PTA of the lower limbs arteries. The results in this series appear to be good from an hemodynamic point of view, with neither morbidity nor mortality.

Adult↗
PubMed1999

Common brachiocephalic trunk: strategies for revascularization.

BACKGROUND: A common brachiocephalic trunk, in which both common carotid arteries and the right subclavian artery arise from a single trunk off the arch, is a normal variant of aortic arch branching that occurs in approximately 10% of the population. Because three of the four primary sources of cerebral blood flow arise from a single aortic branch, stenosis or occlusion of a common trunk can cause severe ischemic consequences. Common trunk revascularization has been described, but there have been no reports focusing on the management options for occlusive disease of this vascular anatomy. METHODS: A retrospective review of our experience with innominate artery revascularization identified 6 patients who underwent revascularization of a common brachiocephalic trunk between 1977 and 1997. All patients were symptomatic, with either total occlusion (n = 3) or critical stenosis (n = 3) caused by atherosclerosis (n = 5) or Takayasu's arteritis (n = 1). Revascularization was achieved by a prosthetic bypass graft from the ascending aorta to the innominate or left common carotid arteries or both (n = 5); or transarterial endarterectomy (n = 1). Concomitant endarterectomy of branch vessels was performed in 3 patients. RESULTS: There was one perioperative death from myocardial infarction, and one perioperative stroke, with death occurring 1 month after hospital discharge. One patient developed cerebral hyperperfusion syndrome 1 week after endarterectomy that resolved without sequelae with antihypertensive medications. During a follow-up period ranging from 1 to 20 years, there was one late death from congestive heart failure 5 years after operation. All surviving patients are alive and free from symptomatic recurrence. CONCLUSIONS: Revascularization for occlusive disease of a common brachiocephalic trunk can be achieved with effective and durable relief of symptoms using either a prosthetic bypass graft or endarterectomy. However, neurologic complications in 2 patients, which were fatal in 1, attest to the potential cerebral ischemic threat posed by occlusive disease of a common brachiocephalic trunk.

Adult↗
PubMed2003

The implications of common brachiocephalic trunk on associated congenital cardiovascular defects and their management.

A common brachiocephalic trunk is an anatomic variant in which both common carotid arteries and the right subclavian artery arise from the aortic arch via a single trunk. The impact of this condition on associated congenital cardiac malformations is presently unknown. Out of a total of 1480 cardiac catheterizations performed in children over a period of 10 years, we discovered 48 patients (3.2%) to have a common brachiocephalic trunk, of whom 98% had associated congenital cardiac malformations. A spectrum of associated lesions was identified, including left-to-right shunts in 19 patients, right-sided anomalies in 18 patients, left-sided obstructive lesions in 12 patients, and coronary arterial abnormalities in 10 patients, eight of whom had other cardiac defects. Genetic syndromes were present in one-fifth of the cases. When found with left-sided malformations, the common trunk was associated with persistent hypoplasia of the aortic arch, likely related to diminished flow through the arch during development. In each of four patients in whom the brachiocephalic trunk had been used during construction of a palliative shunt, we observed inadequate growth and deformation of the pulmonary arteries. Thus, angiographic identification of a common brachiocephalic trunk may be a marker for the presence of accompanying congenital cardiac defects and coronary arterial abnormalities. Understanding the pathophysiologic effects of the common trunk is important when planning the palliative or corrective procedures, and when assessing the potential benefit of the surgical repair over the long term.

Brachiocephalic Trunk↗
PubMed1975

[Surgery of occlusive lesions of the brachiocephalic trunk].

A detailed analysis of 33 cases of operations on the brachiocephalic trunk is reported. An experience with surgical treatment for occlusive lesions of the brachiocephalic trunk of various etiology to liquidate chronic ischemia of the brain has evidenced that in aorto-arteritis the prosthesizing of the brachiocephalic trunk with synthetic prosthesis yields the most favourable results.

Adolescent↗
PubMed2005

A new variant of aberrant left brachiocephalic trunk in mam: case report and literature review.

Importance is placed on aberrant arteries in the radiological and surgical literature. A normal left brachiocephalic trunk is characteristic for the right aortic arch. However, an aberrant left brachiocephalic trunk arising as the last branch of the aortic arch on the left side has not yet been described in the literature. Described here is a new variant of the retro-oesophageal aberrant left brachiocephalic trunk, occasionally observed in a patient during diagnostic investigation or surgical treatment for steno-obstructive involvement of the carotid district. The triple anomaly of the left aortic arch consisted of: 1. the presence of a hypoplastic left brachiocephalic trunk behind the oesophagus, 2. the absence of a brachiocephalic trunk on the right side and 3. separate origins of the arteries on the right side, with the right common artery preceding the right subclavian artery. In front of the trachea an 8-mm prosthetic PTFE was implanted from the proximal segment of the right subclavian artery to the junction of the left common carotid and left subclavian arteries. The author demonstrates the inadequacy of auxiliary investigations to detect aberrant arteries, which may only be identified precisely intra-operatively.

Angiocardiography↗
PubMed2005

The variability and morphometry of the brachiocephalic trunk in human foetuses.

In prenatal and pediatric cardiovascular surgery knowledge of the various arrangements of the aortic arch and its branches as well as the normative data are essential. The variability and morphometric features of the brachiocephalic trunk in 131 human foetuses (65 male, 66 female) ranging from 15 to 34 weeks of gestation were studied by means of anatomical, digital and statistical methods. In all the foetuses examined the left aortic arches were found to have three different arrangements. In 74.05% of cases the usual pattern of the aortic arch with its three main branches were observed. A common origin of the brachiocephalic trunk and left common carotid artery occurred in 20.61% of individuals. In 5.34% of cases the left vertebral artery was an additional vessel and arose from the aortic arch between the left common carotid and subclavian arteries. No significant gender differences were found with respect to the brachiocephalic trunk (p > or = 0.05). The developmental increase in length (r1 = 0.78) and diameter (r2 = 0.83) correlated with a linear function but the increase in volume in relation to age corresponded to a quadratic function (r3 = 0.73). Our results show the largest increases in the brachiocephalic trunk according to the following parameters: the length - between the 4(th) and 5(th), and 7(th) and 8(th) months, diameter - between the 8(th) and 9(th) months and volume - between the 4(th) and 5(th), and 7(th) and 9(th) months of gestation (p < or = 0.01). The present study constructs a normal range for the morphometric features of the foetal brachiocephalic trunk.

Anthropometry↗
PubMed2005

The right aortic arch with mirror-image branching of brachiocephalic arteries and aplasia of the left brachiocephalic trunk: surgically cured rare cause of cerebrovascular insufficiency.

A clinical case with rare anomaly: right aortic arch with mirror-image branching of brachiocephalic arteries and aplasia (isolation) of the left brachiocephalic trunk, causing cerebrovascular insufficiency and left arm claudication is described. Despite the clear neurologic manifestations of cerebrovascular insufficiency and absence of the pulse on the left arm, the pathology was not diagnosed until 35 years of age. The anomaly was diagnosed and surgically cured in the Department of Vascular Surgery of Vilnius University Emergency Hospital. Using transsternal median thoracotomy approach, 12 mm diameter PTFE vascular graft, arising from the ascending aorta and connected to the angle, made of branching left common carotid and left subclavian arteries, was implanted into the position of missing left brachiocephalic trunk. 3 years after surgery patient feels healthy and is working. To our knowledge this is the first reported case of surgical replacement of missing left brachiocephalic trunk in the right-sided aortic arch with mirror-image branching of brachiocephalic arteries.

Adult↗
PubMed1998

Feasibility of intraoperative balloon angioplasty and additional stent placement of isolated stenosis of the brachiocephalic trunk.

OBJECTIVE: We sought to evaluate the feasibility and results of intraoperative balloon angioplasty and additional stent placement of isolated stenosis of the brachiocephalic trunk. PATIENTS AND METHODS: Between May 1993 and October 1996, we treated eight patients with local stenosis of the innominate artery. Seven lesions were situated in the proximal and one in the middle third of the brachiocephalic trunk. Five patients were men and three were women, with ages ranging from 55 to 72 years (mean 59.5 years). All stenoses provoked severe blood flow reduction and caused clinical symptoms. Procedures were performed in an operating suite with fluoroscopic imaging capabilities. Through an anterolateral cervical approach the right common carotid artery was surgically exposed and then clamped to avoid atheroembolization during the subsequent procedure. Retrograde catheterization was performed to reach the stenosis of the brachiocephalic trunk. The lesion was dilated with a balloon catheter and successively stented. Follow-up examinations (color-coded duplex sonography, accompanied by clinical inspection and systolic blood pressure) were scheduled every 6 months. RESULTS: In all patients the dilation of the stenosis of the innominate artery and the stent placement were successful without any side effects. No embolic events or other complications occurred. The postintervention angiography showed successfully dilated stenoses and patent stents in all cases. The technical success rate was 100%. CONCLUSIONS: On the basis of our preliminary data, we believe that, in selected patients, intraoperative balloon angioplasty of stenosis of the innominate artery with stent placement from the right common carotid artery approach is a safe and effective alternative to conventional operations.

Aged↗
PubMed1983

Surgical management of obliterative disease of the brachiocephalic trunk. Experience from 24 cases.

Transsternal endarterectomy was performed in 24 patients for symptomatic obliterative disease of the brachiocephalic trunk in the period 1961-1981. In 10 of the patients the vessel was occluded, and in 14 there were various degrees of stenosis. Reversal of vertebral artery flow was found in 15 patients. Subclavian steal-carotid recovery phenomenon was present in six patients, and one patient had reversed flow in both the right vertebral and the common carotid artery. Only 10 of the 24 patients were free from obliterative changes in other extracranial arteries. After the reconstruction, the blood flow in the brachiocephalic trunk increased from 370 to 610 ml/min in patients with stenosis, and from 0 to 692 ml/min in patients with occlusion. The flow rate changed in the right vertebral artery from -58 to + 119 ml/min and in the right common carotid artery from 116 to 340 ml/min. Two patients died in the early postoperative period (8.5%) and six died during the follow-up period. Follow-up was possible in 21 patients. The result of endarterectomy was assessed as cure in 14, improvement in two and failure in three patients. Stroke occurred in two patients.

Adult↗
PubMed2005

Aberrant patent ductus arteriosus associated with double brachiocephalic trunk and interrupted left subclavian artery.

Although patent ductus arteriosus (PDA) is the most common type of extracardiac shunt, aberrant PDA associated with other cardiac malformations as double brachiocephalic trunk and interrupted left subclavian artery is extremely rare. To the best of our knowledge, the literature contains no other report of a patient who has PDA originated from left subclavian artery associated with ventricular septal defect (VSD), double brachiocephalic trunk and interrupted left subclavian artery.

Abnormalities, Multiple↗
PubMed1983

[Diverticulum of the brachiocephalic trunk--angiographic image and embryologic significance].

A diverticulum of the brachiocephalic trunk is described in 5 children with unilateral absence of the pulmonary artery, in a child with tetralogy of Fallot, and in an other child with Bland-White-Garland syndrome. The diverticulum is a remnant of a contralateral ductus arteriosus, which cLosed after birth and represents the origin of the distal part of the sixth aortic arch.

Aortography↗
PubMedDate not supplied

[Clinical case of the month. Cerebrovascular accident related to arterial brachiocephalic trunk stenosis].

The authors report the case of a 47-year old man, admitted for syncope and left-sided motor deficit. Diagnostic investigations revealed a right middle cerebral artery embolic stroke, secondary to a critical stenosis of the arterial brachiocephalic trunk, harboring a floating thrombus. The treatment options for occlusive lesions of the brachiocephalic trunk are discussed, as well as the optimal delay between stroke and brain revascularization.

Brachiocephalic Trunk↗
PubMed2005

Stroke attributable to a calcific embolus from the brachiocephalic trunk.

BACKGROUND AND PURPOSE: Calcific brain embolization is a rare event that is usually secondary to cardiac valve calcification. We present a case of stroke caused by embolization of calcific material from the brachiocephalic trunk, probably induced by radiotherapy. SUMMARY OF CASE: A 56-year-old right-handed female developed left-sided hemiparesis, hemihypesthesia, and sensory inattention. She had a history of right breast carcinoma that was excised 8 years previously followed by radiotherapy. She had no other history of note. Computed tomography of the head and magnetic resonance imaging confirmed a calcific embolus in right middle cerebral artery and an acute infarction in the corresponding territory. Plain chest radiography, carotid ultrasonography, transthoracic and transoesophageal echocardiography failed to demonstrate the source of calcific embolism. Computed tomography of the thorax revealed heavy calcification of the brachiocephalic trunk and the origin of the right common carotid artery. CONCLUSIONS: Undertaking a vigilant systematic search for the source in cases of calcific embolization is necessary. The aorta and its main branches are possible, yet unusual, sources of calcific emboli that merit investigation.

Atherosclerosis↗
PubMed1999

[Posttraumatic aneurysm of the brachiocephalic trunk: a rare injury].

We report on a posttraumatic aneurysm of the brachiocephalic trunk, something which is rather rare. The injury was caused by blunt chest trauma following a car accident. Computed tomography could not find the brachiocephalic lesion. In patients with fractures of the upper ribs after blunt chest trauma, angiography should be done to exclude severe injuries of the aorta and brachiocephalic vessels.

Adult↗
PubMed1976

Peroperative measurements of blood flow and pressure in occlusion and/or stenosis of the subclavian artery and the brachiocephalic trunk.

Preoperative haemodynamic studies were performed in 60 out of 64 patients operated upon for occlusive disease of the subclavian artery. The pressure differences over the occlusive lesion were recorded in 53 patients. Blood flow was studied in 56 patients with the aid of electromagnetic flowmetry. The average mean pressure difference was 30 mmHg in 6 patients with occlusion of the brachiocephalic trunk and 20 mmHg in 20 patients with left subclavian artery occlusion. In 3 patients with right subclavian occlusion it was 17 mmHg. The highest individual mean pressure differences were found in patients with multiple occlusive lesions in extracranial cephalic arteries. Stenoses of the brachiocephalic trunk and the subclavian arteries in general caused a lower average mean pressure difference than the occlusions. Vertebral blood flow in cases of occlusion of the proximal part of the subclavian artery was usually reversed.

Adult↗