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Surgery
Complex aortic-arch pseudoaneurysm with aorto-innominate vein fistula in a case of traumatic chest injury
  1. Rohit Mehra1,
  2. Pranati Swain1,
  3. Rohit Aggarwal2 and
  4. Dhanalakshmi Balasubramaniam3
  1. 1Department of Vascular and Endovascular Surgery, Command Hospital (Southern Command), Pune, Maharashtra, India
  2. 2Department Radiodiagnosis, Command Hospital (Southern Command), Pune, Maharashtra, India
  3. 3Department of Radiodiagnosis, Army Institute of Cardio-Thoracic Sciences, Pune, Maharashtra, India
  1. Correspondence to Dr Rohit Mehra; capocrimini.rohit{at}gmail.com

Abstract

A patient in his late 30s presented with issues of retrosternal chest pain and palpitations. He had sustained a splinter injury to the left hemithorax a year ago for which he had been managed with a tube thoracostomy. During subsequent evaluations, he was found to have atrial fibrillations and a CT angiography revealed an arch of the aorta pseudoaneurysm with a fistulous communication with the innominate vein, which being a rare condition has no established treatment protocols. Endovascular salvage of the condition required an aortic Ishimaru zone 2 deployment of the thoracic endovascular aortic repair stent graft to provide an adequate landing zone. The elective left subclavian artery revascularisation was obtained by a left carotid artery to left subclavian artery bypass. Post procedure there was complete exclusion of the pseudoaneurysm sac, and the fistulous aorto-venous communication inflow tract. The patient recuperated well and has returned to full active duties.

  • Arteries
  • Vascular surgery

https://doi.org/10.1136/bcr-2024-260184

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: RM, PS, RA and DB. The following authors gave final approval of the manuscript: RM.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.