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Published on: July 11, 2013
Acute repair of aorta-innominate vein fistulas
G D Roye1, G L Zorn, D C McGiffin
1Department of Surgery, University of Alabama at Birmingham 35294-0007, USA.
Insights
Successfully managing aorta-left innominate vein fistulas requires prompt surgical repair. Utilizing cardiopulmonary bypass with circulatory arrest and preoperative arteriography improves outcomes for these lethal vascular injuries.
Area of Science:
- Vascular Surgery
- Trauma Management
- Cardiopulmonary Bypass
Background:
- Penetrating injuries to central vasculature, particularly aorta-left innominate vein fistulas, are associated with high mortality.
- Previous reports indicate late presentation of these injuries, complicating management.
- Optimal surgical timing and techniques for these rare fistulas remain critical.
Observation:
- Three cases of aorta-left innominate vein fistulas were successfully managed.
- A short interval between injury and surgical repair was noted in these cases.
- Cardiopulmonary bypass with total circulatory arrest was employed during repair.
Findings:
- Preoperative arteriography was instrumental in planning the surgical approach.
- Prompt surgical intervention within a short interval post-injury led to successful outcomes.
- The availability of comprehensive radiologic and surgical resources at a trauma center was crucial.
Implications:
- Early diagnosis and rapid surgical intervention are key to improving survival rates for aorta-left innominate vein fistulas.
- Cardiopulmonary bypass with circulatory arrest provides a viable option for complex central vascular repairs.
- Trauma center resources are essential for managing highly lethal vascular injuries effectively.
Abstract:
Penetrating wounds of the central vasculature are highly lethal. Ten cases of aorta-left innominate vein fistulas have been reported in the past, but most have presented late after injury. We report three successfully managed cases that had a short interval between injury and repair, and where we used cardiopulmonary bypass with total circulatory arrest. Preoperative arteriography facilitated planning the operative approach. The ready availability of complete radiologic and surgical resources at a trauma center were responsible for the successful outcome of these highly lethal central vascular injuries.
