Surgical treatment of giant innominate artery aneurysm

Abstract

Innominate artery aneurysms are rare. A 39-year-old male patient, who had chest tightness several years previously, was referred to our hospital because of an upper right mediastinal mass detected from chest X-ray. Computed tomography revealed an innominate artery aneurysm. Cerebral perfusion pressure was monitored with bilateral radial blood pressure and using cerebral oximeter, which is an easy and useful perioperative approach. We successfully performed reconstruction of the innominate artery with a synthetic graft without cardiopulmonary bypass.

A 39-year-old man, with no prior medical history, suffered from chest tightness over several years. However, he did not present any specific physical findings. Chest X-ray showed an abnormal shadow in the right lung field (Figure 1). Three-dimensional chest computed tomography demonstrated a 50 mm × 50 mm innominate artery aneurysm (Figure 2). The patient was hence scheduled for replacement of the aneurysm. Perioperative brain magnetic resonance angiography showed a normal Circle of Willis.

Figure 1.

Chest X-ray showing an abnormal shadow in the upper right lung field.

Figure 2.

Three-dimensional chest computed tomography exhibiting a 50 mm × 50 mm innominate artery aneurysm.

We monitored cerebral perfusion pressure using bilateral radial blood pressure and cerebral oximeter during the perioperative period.

Upper hemi-sternotomy was performed. An 8-mm synthetic graft was anastomosed to the ascending aorta. The proximal and distal sites of the innominate artery were clamped. The distal anastomosis to the innominate artery was performed without cardiopulmonary bypass. The postoperative course was uneventful. Postoperative three-dimensional chest computed tomography revealed a complete reconstruction of the innominate artery (Figure 3).

Figure 3.

Postoperative three-dimensional computed tomography showing a complete reconstruction of the innominate artery.