title: [Iatrogenic injury of the brachiocephalic arterial trunk and its branches--case report].
abstract: Iatrogenic vascular traumas are increasing and their proportion exceeds 40% of all vascular injuries. We report on a rare case of iatrogenic injury of the brachiocephalic arterial trunk during surgical intervention due to postirradiation arteriopathy, which was successfully treated with a silver prosthesis graft. A 58-year-old male underwent surgery for metastases of papillary carcinoma of the thyroid gland, located in lymph nodes adjacent to the right common carotid artery and right subclavian artery. During the surgery, there was an intraoperative injury of the brachiocephalic arterial trunk that included spontaneous rupture and tear of the subclavian and common carotid artery, as the result of extreme fragility of the arterial wall, probably due to the previous irradiation therapy. Emergency sternotomy and clavicle resection were followed by blood flow reconstruction by use of an Y prosthesis that was applied for terminoterminal anastomosis between the brachiocephalic trunk to common carotid artery and subclavian artery. The authors concluded that irradiation therapy may lead to progressive arteriopathy in affected arteries.
authors.affiliation: Klinika za opću kirurgiju, Sv. Duh , Zagreb.
authors.forename: Tomislav
authors.initials: T
authors.lastname: Trajbar
authors.forename: Tugomir
authors.initials: T
authors.lastname: Gverić
authors.forename: Dragutin
authors.initials: D
authors.lastname: Kosuta
authors.forename: Ante
authors.initials: A
authors.lastname: Ivkosić
authors.forename: Predrag
authors.initials: P
authors.lastname: Pavić
authors.forename: Ivan
authors.initials: I
authors.lastname: Zoricić
authors.forename: Visnja Nesek
authors.initials: VN
authors.lastname: Adam
mesh_terms: D019917:Blood Vessel Prosthesis Implantation; D016122:Brachiocephalic Trunk / Q000293:injuries* / Q000528:radiation effects / Q000601:surgery; D020212:Carotid Artery Injuries / Q000209:etiology*; D017536:Carotid Artery, Common; D006801:Humans; D007431:Intraoperative Complications; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck; D011832:Radiation Injuries; D013348:Subclavian Artery / Q000293:injuries* / Q000528:radiation effects / Q000601:surgery; D013964:Thyroid Neoplasms / Q000532:radiotherapy / Q000601:surgery