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. 1976 Dec;31(6):753–756. doi: 10.1136/thx.31.6.753

Repair of traumatic aortic arch to innominate vein fistula under deep hypothermia and circulatory arrest.

D Astolfi, D di Carlo, G di Eusanio, C Marcelletti
PMCID: PMC470506  PMID: 797045

Abstract

Penetrating injuries of the thoracic aorta are usually rapidly lethal. Few patients survive for long enough to undergo surgical treatment. When penetrating injuries of the thoracic aorta are complicated by arteriovenous fistula a correct preoperative diagnosis is important for adequate planning of the surgical repair, and so selective angiography is essential. The best approach is through a median sternotomy with the use of total cardiopulmonary bypass with or without deep hypothermia and circulatory arrest. Fistulae between aorta and innominate vein invariably lead to congestive cardiac failure. A review of the literature suggests that signs of cardiac failure rarely appear early. Congestive failure developed within 30 days of the initial trauma in only two of the 12 reported cases. In our case, the early onset of cardac failure refractory to therapy and the appearance of an expanding pulsatile mass at the base of the neck, threatening rupture, necessitated emergency surgical treatment.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BORST H. G., SCHAUDIG A., RUDOLPH W. ARTERIOVENOUS FISTULA OF THE AORTIC ARCH: REPAIR DURING DEEP HYPOTHERMIA AND CIRCULATORY ARREST. J Thorac Cardiovasc Surg. 1964 Sep;48:443–447. [PubMed] [Google Scholar]
  2. Beall A. C., Roof W. R., De Bakey M. E. Successful Surgical Management of Through-and-Through Stab Wound of the Aortic Arch. Ann Surg. 1962 Nov;156(5):823–826. doi: 10.1097/00000658-196211000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Brickman R. D., Yates A. J., Crisler C., Schwentker E., Bron K., Bahnson H. T. Circulatory arrest during profound hypothermia. For treatment of complicated disease of major vessels. Arch Surg. 1971 Aug;103(2):259–264. doi: 10.1001/archsurg.1971.01350080175027. [DOI] [PubMed] [Google Scholar]
  4. CONRAD J. K., CARTWRIGHT R. S., MOSTYN E. M. Arteriovenous fistula of the aortic arch. Report of a case with hemodynamic data. N Engl J Med. 1962 Jul 5;267:15–19. doi: 10.1056/NEJM196207052670104. [DOI] [PubMed] [Google Scholar]
  5. Fujise Y., Nakayama K., Inatomi B., Shinozaki T., Tamura N. [Successfully treated case of arteriovenous fistula of the aortic arch and left brachio-cephalic vein due to trauma]. Shujutsu. 1970 Jun;24(6):793–799. [PubMed] [Google Scholar]
  6. Giraud R. M. Arteriovenous fistula of the aortic arch complicating stab wound of the neck. S Afr Med J. 1965 Jun 12;39(21):474–476. [PubMed] [Google Scholar]
  7. Jeresaty R. M., Khan A. H., Knight H. F. Traumatic aorticopulmonary fistula. Cardiology. 1972;57(6):358–364. doi: 10.1159/000169534. [DOI] [PubMed] [Google Scholar]
  8. LEVEEN H. H., CERRUTI M. M. SURGERY OF LARGE INACCESSIBLE ARTERIOVENOUS FISTULAS. Ann Surg. 1963 Aug;158:285–289. doi: 10.1097/00000658-196308000-00023. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. McCOOK W. W. Arteriovenous fistula of the aortic arch. J Thorac Surg. 1952 Mar;23(3):299–302. [PubMed] [Google Scholar]
  10. PARMLEY L. F., MATTINGLY T. W., MANION W. C. Penetrating wounds of the heart and aorta. Circulation. 1958 May;17(5):953–973. doi: 10.1161/01.cir.17.5.953. [DOI] [PubMed] [Google Scholar]
  11. PROCTOR W. H., Jr Arteriovenous fistula of the aortic arch; report of a case with successful treatment. J Am Med Assoc. 1950 Nov 4;144(10):818–819. doi: 10.1001/jama.1950.02920100006002. [DOI] [PubMed] [Google Scholar]
  12. Quijano Pitman F., Plaza Celemín L., Naranjo Cordero J., Rey Domínguez L. Fístula arteriovenosa traumática entre el cayado aórtico y el tronco venoso braquiocefálico (vena innominada) Arch Inst Cardiol Mex. 1969 Mar-Apr;39(2):282–289. [PubMed] [Google Scholar]
  13. SEALY W. C., FAWCETT B. Arteriovenous fistula of ascending aorta and left innominate vein; report of a case with successful surgical repair. Ann Surg. 1955 Aug;142(2):302–303. doi: 10.1097/00000658-195508000-00020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Symbas P. N., Sehdeva J. S. Penetrating wounds of the thoracic aorta. Ann Surg. 1970 Mar;171(3):441–450. doi: 10.1097/00000658-197003000-00020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Tarlov E., Greenfield L. J. Post-traumatic aortic arch aneurysm with arteriovenous fistula to the innominate vein. J Thorac Cardiovasc Surg. 1968 Jan;55(1):134–140. [PubMed] [Google Scholar]
  16. Treiman R. L., Cohen J. L., Gaspard D. J., Gaspar M. R. Early surgical repair of acute post-traumatic arteriovenous fistulas. Arch Surg. 1971 Jun;102(6):559–561. doi: 10.1001/archsurg.1971.01350060023008. [DOI] [PubMed] [Google Scholar]

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