Sage Journals: Discover world-class research

Abstract

Purpose:

To describe the occurrence of a false aneurysm after percutaneous transluminal angioplasty of a severely calcified, high-grade stenosis of the brachiocephalic trunk.

Case Report:

A 68-year-old patient was admitted with cerebrovascular insufficiency, right upper extremity ischemia, and recurrent amaurosis fugax. Magnetic resonance arteriography (MRA) and duplex ultrasound revealed a severely calcified, high-grade stenosis of the innominate artery. Balloon dilation of this lesion was performed with minimal morphological success. After dilation, the patient suffered a reversible ischemic neurological deficit, from which he recovered completely. The patient's symptoms improved, but after 3 weeks he was re-admitted with palsy of the recurrent laryngeal nerve. An MRA showed a false aneurysm at the dilation site. Open surgery was performed, and the patient received a bifurcated aorto-subclavian-carotid bypass graft. He was discharged free of his preoperative symptoms.

Conclusions:

This case illustrates the potential hazards of angioplasty of severely calcified stenoses of the supra-aortic vessels.

Keywords

innominate artery stenosis calcification balloon angioplasty neurological complication subclavian steal bypass grafting

Get full access to this article

View all access options for this article.

References

Van Damme

Caudron

Defraigne

. Brachiocephalic arterial reconstruction. Acta Chir Belg. 1992; 92: 37–45.

Wylie

Effeney

. Surgery of the aortic arch branches and vertebral arteries. Surg Clin North Am. 1979; 59: 669–680.

Huttl

Nemes

Simonffy

. Angioplasty of the innominate artery in 89 patients: Experience over 19 years. Cardiovasc Intervent Radiol, 2002; 25: 109–114.

Dorros

Lewin

Jamnadas

. Peripheral transluminal angioplasty of the subclavian and innominate arteries utilizing the brachial approach: Acute outcome and follow-up. Cathet Cardiovasc Diagn. 1990; 19: 71–6.

Korner

Baumgartner

. PTA of the subclavian and innominate arteries: Long-term results. Vasa. 1999; 28: 117–122.

Hebrang

Maskovic

Tomac

. Percutaneous transluminal angioplasty of the subclavian arteries: Long-term results in 52 patients. AJR Am J Roentgenol. 1991; 156: 1091–1094.

Mathias

Luth

Haarmann

. Percutaneous transluminal angioplasty of proximal subclavian artery occlusions. Cardiovasc Intervent Radiol. 1993; 16: 214–218.

Khan

Wattanasauwan

Ansari

. Painless aortic dissection presenting as hoarseness of voice: Cardiovocal syndrome: Ortner's syndrome. Am J Emerg Med. 1999; 17: 361–363.

Kishan

Wongpraparut

Adeleke

. Ortner's syndrome in association with mitral valve prolapse. Clin Cardiol. 2000; 23: 295–297.

10.

Day

Walesby

. A spontaneous ductal aneurysm presenting with left recurrent laryngeal nerve palsy. Ann Thorac Surg. 2001; 72: 608–609.

11.

Ketonen

Meurala

Harjola

. Management of arteriosclerotic aneurysms of the innominate and subclavian arteries. Scand J Thorac Cardiovasc Surg. 1983; 17: 129–133.

12.

Millaire

Trinca

Marache

. Subclavian angioplasty: Immediate and late results in 50 patients. Cathet Cardiovasc Diagn. 1993; 29: 8–17.

13.

Joseph

Mandalam

Rao

. Percutaneous transluminal angioplasty of the subclavian artery in nonspecific aortoarteritis: Results of long-term follow-up. J Vasc Interv Radiol. 1994; 5: 573–580.

14.

Ahn

Eton

Moore

. Endovascular surgery for peripheral arterial occlusive disease. A critical review. Ann Surg. 1992; 216: 3–16.

False Aneurysm after Balloon Dilation of a Calcified Innominate Artery Stenosis