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[Stenoses and occlusions of the innominate trunk (author's transl)]
Insights
Doppler ultrasound can safely detect innominate artery stenosis or occlusion, even when near the aorta. Most patients remain asymptomatic due to vascular bypasses, suggesting limited need for invasive diagnostics or surgery.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Neurology
Context:
- Innominate trunk stenoses and occlusions are rare vascular conditions.
- Accurate diagnosis is crucial for appropriate patient management.
- Doppler ultrasound is a non-invasive imaging modality.
Purpose:
- To evaluate the safety and efficacy of Doppler ultrasound in diagnosing innominate trunk stenoses and occlusions.
- To correlate ultrasound findings with neuroradiologic and surgical data.
- To assess the clinical presentation and outcomes of patients with innominate trunk disease.
Summary:
- Doppler ultrasound can safely identify stenoses and occlusions of the innominate trunk, even those located close to the aorta.
- The majority of patients (78%) with these conditions are asymptomatic or have non-specific symptoms due to the formation of collateral vascular pathways.
- Neurological deficits or hypoperfusion symptoms were observed in only a small fraction of cases, indicating a generally benign clinical course.
Impact:
- Findings suggest that Doppler ultrasound is a reliable diagnostic tool for innominate trunk disease.
- The study advocates for judicious use of invasive diagnostic procedures.
- Recommendations are made to limit surgical intervention until the natural history and risks of cerebral injury are better understood.
Abstract:
Direct comparison with neuroradiologic and surgical data show that stenoses and occlusions of the innominate trunk may be recognized safely by Doppler ultrasound despite localisation close to the aorta. Formation of sonographically demonstrable and haemodynamically complicated vascular by-passes is the reason for the mainly asymptomatic or very uncharacteristic complaints of these cases (78%) among the relatively rare stenosing occlusions of the lumen (0,65%) of the innominate trunk (18 out of 2768 patients). Only in four cases were there focal neurological losses or symptoms of hypoperfusion of the arm. Invasive diagnostic measures should thus be used sparingly. The indication for vascular surgery should be limited to a few cases as long as the natural course of these extracranial vascular changes and the risk of cerebral injury have not been established with certainty.