“Isolated Innominate Artery Aneurysm: A Very Rare Finding”

Case Report

Austin J Clin Case Rep. 2014;1(9): 1041.

“Isolated Innominate Artery Aneurysm: A Very Rare Finding”

Elia De Maria1*, Alina Olaru2 and Stefano Cappelli1

1Cardiology Unit, Ramazzini Hospital, Italy

2Department of Cardiology, University of Modena and Reggio Emilia, Italy

*Corresponding author: Elia De Maria, Cardiology Unit, Ramazzini Hospital, Via Molinari 1, 41012, Carpi (Modena), Italy

Received: July 31, 2014; Accepted: September 01, 2014; Published: September 03, 2014

Abstract

We describe the clinical case of an elderly woman with an aneurysm of right innominate artery, treated conservatively. The aneurysms of supraortic trunks and internal carotid artery are very rare (0.4-4% of all types of aneurysms); even rarer is the presence of aneurysms of subclavian and innominate artery (0.003%). Etiology is multifactorial and atherosclerosis accounts for 60% of cases. The clinical presentation is variable and the most common sign is the presence of a pulsatile mass on one side of the neck. In critically symptomatic patients, when rupture or embolization occurs, emergency treatment is mandatory. The most appropriate treatment is still controversial when aneurysm is asymptomatic and diameter is >30 mm.

Keywords: Aneurysm; Innominate artery; Supraortic trunks

Introduction

The aneurysms of supraortic trunks and internal carotid artery are very rare (0.4-4% of all types of aneurysms); isolated aneurysms of subclavian and innominate artery are even rarer, with an incidence reported in literature of 0.003% [1,2]. In this report we describe the case of an elderly female patient with an aneurysm of the right innominate artery and mild dilatation of the proximal part of homolateral subclavian artery, diagnosed after the appearance of a pulsatile mass on the right side of the neck.

Case Presentation

An 80-year-old woman was evaluated in our Hospital because of the appearance (few months before) of a pulsatile mass on the right side of the neck, associated with a vascular systolic murmur. She denied past or recent trauma to her neck or upper thorax; no central venous access had ever been placed or attempted. Her past medical history was only characterized by arterial hypertension, well controlled with Ramipril 5 mg daily. A recent echocardiogram showed a mild left ventricular hypertrophy with preserved systolic function, normal dimensions of aortic root and ascending segment, no evidence of valve disease. Blood exams were all within normal ranges (red and white blood cells, platelets count, coagulation tests, creatinine, electrolyte levels, thyroid and liver function tests, cholesterol level). For further evaluation she first underwent an Echo Doppler ultrasound evaluation of supraortic trunks that showed an enlargement of the innominate and right subclavian artery. Abdominal aortic aneurysm was excluded. Therefore a multiplanar Computed Tomographic Angiography (CTA) was performed. This exam showed an aneurysm of the right innominate artery (maximum diameter of 19.6 mm, with a tortuous course); also the proximal part of homolateral subclavian artery was dilated (13 mm diameter) (Figure 1A-1B). CTA was completed with a 3D reconstruction of arterial anatomy (Figure 2A-2B): right innominate artery dilatation and kinking were clearly evident. Infectious, autoimmune and connective tissue diseases were excluded as possible causes of aneurysm; in particular there was no clinical or hematological sign of bacterial, viral, mycotic infections (negative tests, negative blood cultures and negative antibodies for Staphylococcus species, syphilis, mycotic infection, tuberculosis, hepatitis A, B, and C). Rheumatoid Factor and autoimmune antibodies were all negative (anti-nuclear, anti-DNA, anti-mitochondria, anti-smooth muscle, anti-tireoglobulin, anti-thyroid peroxidase, anti-TSH receptor). Moreover there was no sign of connective tissue disorders like Marfan or Ehlers-Danlos syndromes. At this point an expert team discussion was carried out, together with a vascular surgeon. We all agreed for an initial conservative approach and follow-up with CTA after 6 months and 1 year. Antiplatelet therapy with aspirin 100 mg daily was started, in association with a beta-blocker (Nebivolol 5 mg daily). At 1 year follow up the patient was substantially asymptomatic (neck pulsation being less evident); a new CTA showed an unchanged situation and surgery has been postponed.

Citation: Maria ED, Olaru A and Cappelli S. “Isolated Innominate Artery Aneurysm: A Very Rare Finding”. Austin J Clin Case Rep. 2014;1(9): 1041. ISSN 2381-912X