| Successful Surgical
Repair of Impending Rupture of a Pseudoaneurysm of the Brachiocephalic
Artery with Prior Reconstruction of the Carotid Artery |
(Division of Cardiovascular Surgery,
Social Insurance Chukyo Hospital, Nagoya, Japan and Division of
Cardiovascular Surgery, Aichi Prefectural Owari Hospital*, Ichinomiya,
Japan)
| Ken Miyahara* |
Masanobu Maeda |
Yoshimasa Sakai |
| Hajime Sakurai |
Hiroomi Murayama |
Hiroki Hasegawa |
|
We report the successful
repair of impending rupture of a pseudoaneurysm of the brachiocephalic
artery (BCA) in a 70-year-old man. He had undergone a mediastinal
tumor resection through a median sternotomy in 1995. Pathological
examination revealed non-Hodgkin's lymphoma. Two years later,
he underwent radiation therapy of 65 Gray for metastasis to the
supraclavicular lymph nodes. On January 18,2000, plastic surgeons
planned to perform a pectoralis major musculocutaneous flap to
repair a radiation skin ulcer. During the operation, the BCA
was lacerated, possibly in an area of radiation tissue damage.
We performed a prosthetic graft (10-mm Gelseal™) replacement
of the BCA. The right subclavian artery had to be ligated. Postoperative
digital subtraction angiography (DSA) showed excellent reconstruction
of the artery. Magnetic resonance angiography of the brain showed
a deficit in the anterior communicating artery and stenosis of
the posterior communicating artery, which indicated that the
reconstruction procedure was reasonable. Seven months later,
on August 18,2000, the patient was transferred to our hospital
because of swelling of the right neck and oozing from the previous
cutaneous wound. CT scan and DSA demonstrated the presence of
a pseudoaneurysm of the proximal anastomosis site, which required
emergency surgery. Before this third sternotomy, a saphenous
vein graft was interposed between both external carotid arteries.
Removal of the prosthetic graft and resection of the pseudoaneurysm
were performed under mild hypothermia and cardiopulmonary bypass
with left common carotid arterial perfusion. Then, the wound
was closed completely using a left pectoralis major musculocutaneous
flap. The postoperative course was uneventful and DSA showed
good patency of the graft and intracranial arteries. The patient
was discharged without neurological complications. We conclude
that prior reconstruction of the carotid artery is a safe and
effective procedure for patients with aneurysmal changes in the
BCA, especially in the case of re-operation.
Jpn. J. Cardiovasc. Surg. 32:52-55 (2003) |
|
