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Endovascular Repair of Innominate Artery Injury Secondary to Air Rifle Pellet: A Case Report and Review of the Literature

Division of Vascular Surgery, Wilford Hall Air Force Medical Center, San Antonio, Texas, gifford{at}uthscsa.edu

John T. Deel, MD

Division of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas

Daniel L. Dent, MD

and Division of Trauma & Emergency Surgery University of Texas Health Science Center at San Antonio, San Antonio, Texas

V. Seenu Reddy, MD, MBA

Division of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas

Todd E. Rasmussen, MD

Division of Vascular Surgery, Wilford Hall Air Force Medical Center, San Antonio, Texas

Objective: Decreased morbidity makes endovascular treatment preferable for certain central aortic and great vessel injuries. We present a case of penetrating innominate injury, describe considerations of a catheter-based approach, and provide follow-up of repair. Methods: A case report and review of the literature. Results: A 16-year-old man presented with an isolated innominate artery injury following an air rifle wound. Standard transfemoral approach was used to gain access the innominate artery. The injury was treated with an 8 x 35 mm, balloon-expandable, covered stent. Completion imaging confirmed a well-positioned stent with exclusion of the injury and normal flow in distal vessels. There were no symptoms of stent migration or stenosis 1 year following the injury. Conclusions: Specific anatomic characteristics including its proximity to the carotid and vertebral arteries make the endovascular approach to the innominate artery unique. This case demonstrates the viability of catheter-based approaches in treating vascular injury.

Key Words: innominate artery • endovascular repair • penetrating arterial injury

This version was published on June 1, 2009

Vascular and Endovascular Surgery, Vol. 43, No. 3, 301-305 (2009)
DOI: 10.1177/1538574408329269


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