Endovascular Treatment of Brachiocephalic and Subclavian Arterial Disease


Objectives: To review our experience of stentgraft deployment for vascular aneurysm or pseudoaneurysm of the brachiocephalic or subclavian artery. Methods: Participants comprised 7 patients (4 men, 3 women; mean age, 61 years; range, 47 - 76 years) who underwent endovascular repair of brachiocephalic or subclavian arterial vascular lesions between July 2001 and November 2008. Causes of vascular lesions were: traffic accident, n = 4; infection, n = 2; and post-irradiation state of esophageal cancer, n = 1. Safety, technical success, and clinical follow-up were evaluated. Results: Stentgraft deployment was successful in all cases. No complications related to stent fracture were encountered during follow-up (up to 2308 days). One male patient with esophageal cancer died of rebleeding from the tracheostomy hole 13 days after treatment with size mismatch between the stentgraft and brachiocephalic artery. Conclusion: Stentgraft deployment represents acceptable treatment for the injured brachiocephalic artery or proximal side of the subclavian artery.

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Y. Baba, S. Hayashi, H. Yamamoto, Y. Imoto and M. Nakajo, "Endovascular Treatment of Brachiocephalic and Subclavian Arterial Disease," Open Journal of Radiology, Vol. 3 No. 1, 2013, pp. 7-11. doi: 10.4236/ojrad.2013.31002.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] D. Demetriades, D. Theodorou, E. Cornwell, T. V. Berne, J. Asensio, et al., “Evaluation of Penetrating Injuries of the Neck: Prospective Study of 223 Patients,” World Jour nal of Surgery, Vol. 21, No. 1, 1997, pp. 41-48. Hdoi:10.1007/s002689900191
[2] D. Demetriades, S. Chahwan, H. Gomez, R. Peng, G. Velmahos, et al., “Penetrating Injuries to the Subclavian and Axillary Vessels,” Journal of the American College of Surgeons, Vol. 188, No. 3, 1999, pp. 290-295. Hdoi:10.1016/S1072-7515(98)00289-0
[3] V. Kalakuntla, V. Patel, A. Tagoe and W. Weaver, “Six Year Experience with Management of Subclavian Artery Injuries,” The American Journal of Surgery, Vol. 66, No. 10, 2000, pp. 927-930.
[4] M. S. Abouljoud, F. N. Obeid, H. M. Horst, V. J. Sorensen, J. J. Fath, et al., “Arterial Injuries of the Thoracic Outlet: A Ten-Year Experience,” The American Journal of Surgery, Vol. 59, No. 9, 1993, pp. 590-595.
[5] M. Bladergroen, R. Brockman, G. Luna, T. Kohler and K. Johansen, “A Twelve-Year Survey of Cervicothoracic Vascular Injuries,” The American Journal of Surgery, Vol. 157, No. 5, 1989, pp. 483-486. Hdoi:10.1016/0002-9610(89)90640-5
[6] R. H. Johnston Jr., M. J. Wall Jr. and K. L. Mattox, “In nominate Artery Trauma: A Thirty-Year Experience,” Journal of Vascular Surgery, Vol. 17, No. 1, 1993, pp. 134-140. Hdoi:10.1016/0741-5214(93)90017-G
[7] J. O. Fulton, M. K. De Groot and U. O. von Oppell, “Stab Wounds of the Innominate Artery,” The Annals of Thoracic Surgery, Vol. 61, No. 3, 1996, pp. 851-853. Hdoi:10.1016/0003-4975(95)01154-4
[8] B. M. Axisa, I. M. Loftus, G. Fishwick, T. Spyt and P. R. Bell, “Endovascular Repair of an Innominate Artery False Aneurysm Following Blunt Trauma,” Journal of Endo vascular Therapy, Vol. 7, No. 3, 2000, pp. 245-250. Hdoi:10.1583/1545-1550(2000)007<0245:EROAIA>2.3.CO;2
[9] G. J. Becker, J. F. Benenati, G. Zemel, D. S. Sallee, C. A. Suarez, et al., “Percutaneous Placement of a Balloon Expandable Intraluminal Graft for Life-Threatening Subclavian Arterial Hemorrhage,” Journal of Vascular and Interventional Radiology, Vol. 2, No. 2, 1991, pp. 225-229. Hdoi:10.1016/S1051-0443(91)72286-0
[10] H. A. Bukhari, R. Saadia and B. W. Hardy, “Urgent En dovascular Stenting of Subclavian Artery Pseudoaneurysm Caused by Seatbelt Injury,” Canadian Journal of Surgery, Vol. 50, No. 4, 2007, pp. 303-304.
[11] T. A. Chandler, G. Fishwick and P. R. Bell, “Endovascular Repair of a Traumatic Innominate Artery Aneurysm,” European Journal of Vascular and Endovascular Surgery, Vol. 18, No. 1, 1999, pp. 80-82. Hdoi:10.1053/ejvs.1999.0871
[12] J. S. Danetz, A. D. Cassano, M. C. Stoner, R. R. Ivatury and M. M. Levy, “Feasibility of Endovascular Repair in Penetrating Axillosubclavian Injuries: A Retrospective Re view,” Journal of Vascular Surgery, Vol. 41, No. 2, 2005, pp. 246-254. Hdoi:10.1016/j.jvs.2004.11.026
[13] D. F. du Toit, A. V. Lambrechts, H. Stark and B. L. Warren, “Long-Term Results of Stent Graft Treatment of Subclavian Artery Injuries: Management of Choice for Stable Patients?” Journal of Vascular Surgery, Vol. 47, No. 4, 2008, pp. 739-743. Hdoi:10.1016/j.jvs.2007.11.009
[14] D. F. du Toit, W. Odendaal, A. Lambrechts and B. L. Warren, “Surgical and Endovascular Management of Penetrating Innominate Artery Injuries,” European Journal of Vascular and Endovascular Surgery, Vol. 36, No. 1, 2008, pp. 56-62. Hdoi:10.1016/j.ejvs.2008.01.024
[15] D. F. du Toit, D. C. Strauss, M. Blaszczyk, R. de Villiers and B. L. Warren, “Endovascular Treatment of Penetrating Thoracic Outlet Arterial Injuries,” European Journal of Vascular and Endovascular Surgery, Vol. 19, No. 5, 2000, pp. 489-495. Hdoi:10.1053/ejvs.1999.1050
[16] K. Kasirajan, B. Matteson, J. M. Marek and M. Langsfeld, “Covered Stents for True Subclavian Aneurysms in Patients with Degenerative Connective Tissue Disorders,” Journal of Endovascular Therapy, Vol. 10, No. 3, 2003, pp. 647-652. Hdoi:10.1583/1545-1550(2003)010<0647:CSFTSA>2.0.CO;2
[17] E. J. Miles, A. Blake, W. Thompson, W. G. Jones and E. L. Dunn, “Endovascular Repair of Acute Innominate Artery Injury Due to Blunt Trauma,” The American Jour nal of Surgery, Vol. 69, No. 2, 2003, pp. 155-159.
[18] J. C. Parodi, C. Schonholz, L. M. Ferreira and J. Bergan, “Endovascular Stent-Graft Treatment of Traumatic Arterial Lesions,” Annals of Vascular Surgery, Vol. 13, No. 2, 1999, pp. 121-129. Hdoi:10.1007/s100169900230
[19] A. V. Patel, M. L. Marin, F. J. Veith, A. Kerr and L. A. Sanchez, “Endovascular Graft Repair of Penetrating Subclavian Artery Injuries,” Journal of Endovascular Surgery, Vol. 3, No 4, 1996, pp. 382-388. Hdoi:10.1583/1074-6218(1996)003<0382:EGROPS>2.0.CO;2
[20] M. Schoder, M. Cejna, T. Holzenbein, G. Bischof, F. Lomoschitz, et al., “Elective and Emergent Endovascular Treatment of Subclavian Artery Aneurysms and Injuries,” Journal of Endovascular Surgery, Vol. 10, No. 1, 2003, pp. 58-65. Hdoi:10.1583/1545-1550(2003)010<0058:EAEETO>2.0.CO;2
[21] E. S. Xenos, M. Freeman, S. Stevens, D. Cassada, J. Pacanowski, et al., “Covered Stents for Injuries of Subclavian and Axillary Arteries,” Journal of Vascular Surgery, Vol. 38, No. 3, 2003, pp. 451-454. Hdoi:10.1016/S0741-5214(03)00553-6
[22] A. G. McKinley, A. T. Carrim and J. V. Robbs, “Management of Proximal Axillary and Subclavian Artery Injuries,” British Journal of Surgery, Vol. 87, No. 1, 2000, pp. 79-85. Hdoi:10.1046/j.1365-2168.2000.01303.x
[23] N. M. Rich, R. W. Hobson, B. S. Jarstfer and T. M. Geer, “Subclavian Artery Trauma,” The Journal of Trauma, Vol. 13, No. 6, 1973, pp. 485-496. Hdoi:10.1097/00005373-197306000-00001
[24] S. M. George Jr., M. A. Croce, T. C. Fabian, E. C. Man giante, K. A. Kudsk, et al., “Cervicothoracic Arterial Injuries: Recommendations for Diagnosis and Management,” World Journal of Surgery, Vol. 15, No. 1, 1991, pp. 134-140. Hdoi:10.1007/BF01658986
[25] D. F. du Toit, J. G. Leith, D. C. Strauss, M. Blaszczyk, J. de V. Odendaal, et al., “Endovascular Management of Traumatic Cervicothoracic Arteriovenous Fistula,” Bri tish Journal of Surgery, Vol. 90, No. 12, 2003, pp. 1516-1521. Hdoi:10.1002/bjs.4343
[26] S. C. Wheeler, K. M. Zinn and T. W. Hughes, “Endovascular Covered Stent Repair of an Iatrogenic Subclavian Artery-To-Pulmonary Artery Fistula and Pseudoaneurysm,” Journal of Vascular and Interventional Radiology, Vol. 18, No. 6, 2007, pp. 775-779. Hdoi:10.1016/j.jvir.2007.02.029
[27] L. H. Phipp, D. J. Scott, D. Kessel and I. Robertson, “Sub clavian Stents and Stent-Grafts: Cause for Concern?” Journal of Endovascular Surgery, Vol. 6, No. 3, 1999, pp. 223-226. Hdoi:10.1583/1074-6218(1999)006<0223:SSASCF>2.0.CO;2
[28] A. F. Lennox, D. R. Logan, R. C. Waugh and J. May, “Endovascular Management of an Innominate-Caval Fistula Secondary to Insertion of a Cardiac Pacemaker,” Circulation, Vol. 102, 2000, pp. E124-125. Hdoi:10.1161/01.CIR.102.19.e124
[29] L. P. Wall, A. Gasparis and E. Criado, “Endovascular Therapy for Tracheoinnominate Artery Fistula: A Tem porizing Measure,” Annals of Vascular Surgery, Vol. 19, No. 1, 2005, pp. 99-102. Hdoi:10.1007/s10016-004-0140-4
[30] C. Sessa, V. Costache, P. Porcu, F. Thony, D. Blin, et al., “Tracheoinnominate Artery Fistula: Combined Endovascular and Surgical Management by Emergency Stent Graft Placement Followed by Cryopreserved Arterial Allograft Repair,” Annals of Vascular Surgery, Vol. 20, No. 6, 2006, pp. 731-735. Hdoi:10.1007/S10016-006-9086-z
[31] W. Y. Szeto, R. M. Fairman, M. A. Acker, C. L. Skelly, J. G. Augoustides, et al., “Emergency Endovascular Deployment of Stent Graft in the Ascending Aorta for Contained Rupture of Innominate Artery Pseudoaneurysm in a Pediatric Patient,” The Annals of Thoracic Surgery, Vol. 81, No. 5, 2006, pp. 1872-1875. Hdoi:10.1016/j.athoracsur.2005.07.046
[32] K. Takasaki, K. Enatsu, M. Nakayama, T. Uchida and H. Takahashi, “A Case with Tracheo-Innominate Artery Fistula. Successful Management of Endovascular Embolization of Innominate Artery,” Auris Nasus Larynx, Vol. 32, No. 2, 2005, pp. 195-198. Hdoi:10.1016/j.anl.2004.11.002
[33] E. M. Marone, G. Esposito, A. Kahlberg, Y. Tshomba, C. Brioschi, et al., “Surgical Treatment of Tracheoinnominate Fistula after Stent-Graft Implantation,” The Journal of Thoracic and Cardiovascular Surgery, Vol. 133, No. 6, 2007, pp. 1641-1643. Hdoi:10.1016/j.jtcvs.2006.12.063

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