Right brachiocephalic artery
, left common carotid artery, and left subclavian artery measured 13 mm, 6 mm, and 11 mm in diameter, respectively.
Computed tomography and corresponding fuorodeoxyglucose positron emission tomography images revealed mural thickening of the proximal left subclavian artery, brachiocephalic artery
, dilated abdominal aorta, bilateral proximal renal arteries, and proximal SMA (Figure 3-6).
Yasa et al reported CCA to be injured in 9/18 cases (50%), ECA in 4/18 cases (22.2%), ICA in 3/18 cases (16.6%) and brachiocephalic artery
in 2/18 cases (11.1%)10.
After the procedure, we observed a flap-like mobile structure in the ascending aorta, above the aortic valve, which had an appearance similar to a second valve proximal to the brachiocephalic artery
(Figure 2, Left).
Dissection involving the aortic arch and ascending aorta are generally considered life-threatening requiring immediate surgical intervention while dissection distal to the right brachiocephalic artery
and descending aorta can be managed medically.
Despite the close proximity of the dislocated head to the brachiocephalic artery
(FIGURE 1B-1D), there was no vascular injury.
The NRILN is a rare anatomical variation and is the result of a vascular anomaly during early embryonic development of the aortic arches and is identified generally by the absence of the brachiocephalic artery
and the formation of an aberrant right subclavian artery (arteria lusoria).
For histological examinations, a perfusion at a pressure of 100 mm Hg with the fixative MorFFFix[R] (Morphisto, Frankfurt am Main, Germany) was performed followed by excision of the carotid arteries, brachiocephalic artery
, and aorta including the renal arteries.
Finally, the patient relative frailty and the favorable anatomic position of the ABF (3 cm above the sinotubular junction and 4 cm below the brachiocephalic artery
) undoubtedly made it feasible.
One filter is placed in the brachiocephalic artery
and the other is set in the left common carotid artery.