Skip to main content
SpringerLink
Log in

Brachiocephalic aneurysm: The case for early recognition and repair

  • Papers from the Peripheral Vascular Surgery 1990 Meeting
  • Published:
Annals of Vascular Surgery

Abstract

Over a 40 year period (1950–1990) only 73 patients were treated surgically for brachiocephalic aneurysms. An operation was performed for 38 subclavian, 25 extracranial carotid, six innominate, three aberrant right subclavian, and one vertebral artery aneurysm. Twenty-three other associated aneurysms occurred in 14 patients. Five patients had an additional untreated brachiocephalic aneurysm, and nine patients had 18 aneurysms located in different anatomic regions. There were 40 men and 33 women with a mean age of 50.5 years (range 16 to 82 years). Forty patients (54.8%) presented with potentially life- or limb-threatening signs or symptoms, including stroke or transient ischemic attacks (31.5%), upper extremity ischemia (19.2%), and rupture (4.1%). Atherosclerosis was most common in innominate aneurysms (66.7%) but also occurred in subclavian (34.1%) and carotid aneurysms (12.0%). Thoracic outlet compression was a common etiology for subclavian aneurysms while trauma or spontaneous dissection was more frequent for carotid aneurysms. Six deaths (8.2%) occurred within 30 days of operation: two from rupture, three in association with concomitant cardiovascular operations, and one from emergency carotid ligation. There were no deaths with elective isolated surgical repair. Overall five and 10 year survival in patients with brachiocephalic aneurysms was 80.8% and 61.4%, respectively. The majority of brachiocephalic aneurysms present with life- or limb-threatening complications and are associated with a high mortality for emergency or concomitant repair. Early elective isolated surgical repair remains the optimal therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. BREWSTER DC, MONCURE AC, DARLING RC, et al. Innominate artery lesions: problems encountered and lesson learned.J Vasc Surg 1985;2:99–112.

    Article  PubMed  CAS  Google Scholar 

  2. PAINTER TA, HERTZER NR, BEVEN EG, et al. Extracranial carotid aneurysms: report of six cases and review of the literature.J Vasc Surg 1985;2:312–318.

    Article  PubMed  CAS  Google Scholar 

  3. DENT TL, LINDENAUER SM, ERNST CB, et al. Multiple arteriosclerotic arterial aneurysms.Arch Surg 1972;105:338–343.

    PubMed  CAS  Google Scholar 

  4. WINSLOW N. Extracranial aneurysms of the internal carotid artery.Arch Surg 1926;13:689–792.

    Google Scholar 

  5. SHEEN W. Original memoirs of ligation of the innominate artery, with report of a successful case.Ann Surg 1905;42:1.

    PubMed  CAS  Google Scholar 

  6. LINDSKOG GE. The surgery of the innominate artery.N Engl J Med 1946;235:71.

    Article  Google Scholar 

  7. ZWOLAK RM, WHITEHOUSE WM, KNAKE JE, et al. Atherosclerotic extracranial carotid artery aneurysms.J Vasc Surg 1984;1:415–422.

    Article  PubMed  CAS  Google Scholar 

  8. SUNDT TM, PEARSON BW, PIEPGRAS DG, et al. Surgical management of aneurysms of the distal extracranial internal carotid artery.J Neurosurg 1986;64:169–182.

    Article  PubMed  Google Scholar 

  9. PAIROLERO PC, WALLS JT, PAYNE WS, et al. Subclavian-axillary artery aneurysms.Surgery 1981;90:757–763.

    PubMed  CAS  Google Scholar 

  10. COSELLI JS, CRAWFORD ES. Surgical treatment of aneurysms of the intra-thoracic segment of the subclavian artery.Chest 1987;91:704–708.

    PubMed  CAS  Google Scholar 

  11. ERIKSEN CA, ROBBS JV. Aneurysms of the great vessels of the aortic arch.J R Coll Surg Edin 1986;31:218–223.

    CAS  Google Scholar 

  12. KAPLAN EL, MEIER P. Nonparametric estimation from incomplete observations.Am Stat Assoc J 1958;June:457–480.

    Google Scholar 

  13. SCHUMACHER PD, WRIGHT CB. Management of arteriosclerotic aneurysm of the innominate artery.Surgery 1979;85:489–495.

    PubMed  CAS  Google Scholar 

  14. THOMAS TV. Intrathoracic aneurysms of the innominate and subclavian arteries.J Thorac Cardiovasc Surg 1972;63:461–471.

    PubMed  CAS  Google Scholar 

  15. KETONEN P, MEURALA H, HARJOLA PT, et al. Management of arteriosclerotic aneurysms of the innominate and subclavian arteries.Scand J Thorac Cardiovasc Surg 1983;17:129–133.

    PubMed  CAS  Google Scholar 

  16. MCOLLUM CH, Da GAMMA AD, NOON GP, et al. Aneurysm of the subclavian artery.J Cardiovasc Surg (Torino) 1979;20:159–164.

    Google Scholar 

  17. HOBSON RW II, SARKARIA J, O'DONNELL JA, et al. Atherosclerotic aneurysms of the subclavian artery.Surgery 1979;85:368–371.

    PubMed  Google Scholar 

  18. BUSUTTIL RW, DAVIDSON RK, FOLEY KT, et al. Selective management of extracranial carotid arterial aneurysms.Am J Surg 1980;140:85–91.

    PubMed  CAS  Google Scholar 

  19. WELLING RE, TAHA A, GOEL T, et al. Extracranial carotid artery aneurysms.Surgery 1983;93:319–323.

    PubMed  CAS  Google Scholar 

  20. RHODES EL, STANLEY JC, HOFFMAN GL, et al. Aneurysms of extracranial carotid arteries.Arch Surg 1976;111:339–343.

    PubMed  CAS  Google Scholar 

  21. MCOLLUM CH, WHEELER WG, NOON GP, et al. Aneurysms of the extracranial carotid artery.Am J Surg 1979;137:196–200.

    PubMed  Google Scholar 

  22. BAHNSON HT. Definitive treatment of saccular aneurysms of the aorta with excision of sac and aortic suture.Surg Gynecol Obstet 1953;96:383.

    PubMed  CAS  Google Scholar 

  23. MAHORNER H, SPENCER R. Shunt grafts: a method of replacing segments of the aorta and large vessels without interrupting the circulation.Ann Surg 1954;139:439.

    PubMed  CAS  Google Scholar 

  24. KIRBY CK, JOHNSON J. Innominate artery aneurysm treated by resection and end-to-end anastomosis.Surgery 1953;33:562.

    PubMed  CAS  Google Scholar 

  25. De BAKEY ME, CRAWFORD ES. Resection and homograft replacement of innominate and carotid arteries with use of shunt to maintain circulation.Surg Gynecol Obstet 1957;105:129.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Vascular Surgery, Department of Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota

    Thomas C. Bower MD, Peter C. Pairolero MD, John W. Hallett Jr MD, Barbara J. Toomey RN, Peter Gloviczki MD & Kenneth J. Cherry Jr MD

Authors
  1. Thomas C. Bower MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter C. Pairolero MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John W. Hallett Jr MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Barbara J. Toomey RN
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Peter Gloviczki MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kenneth J. Cherry Jr MD
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Bower, T.C., Pairolero, P.C., Hallett, J.W. et al. Brachiocephalic aneurysm: The case for early recognition and repair. Annals of Vascular Surgery 5, 125–132 (1991). https://doi.org/10.1007/BF02016744

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02016744

Key words

Search

Navigation