Kraus T W, Paetz B, Richter G M, Allenberg J R
Department for Surgery, University of Heidelberg, Germany.
Ann Vasc Surg. 1993 May;7(3):275-81. doi: 10.1007/BF02000254.
Most supra-aortic aneurysms are localized in the extracranial carotid and subclavian artery. Aneurysms of the brachiocephalic artery (BCA) represent a rather rare finding. Chronic arteriosclerotic changes are responsible for the majority of cases. Posttraumatic BCA damage is only occasionally encountered, complete vascular dissection by perforating injuries being the dominant causative mechanism. Although isolated BCA trauma after blunt thoracic contusion is rare, brachiocephalic injury in association with aortic lesions seems to be the second most common site of vascular injury after the aorta. Cases of isolated blunt BCA trauma documented in the literature to date usually involved a complete avulsion of the artery from the aortic arch or complete rupture near the aortic origin. We present an isolated case of posttraumatic BCA aneurysm in a woman involved in a car accident who suffered blunt chest trauma with a subtotal, near circumferential vessel wall dissection of only the intima and media. Clinical features, diagnostic procedure, surgical treatment, and trauma mechanisms of postcontusional BCA lesions are described and discussed in reference to the literature.
大多数主动脉弓上动脉瘤局限于颅外颈动脉和锁骨下动脉。头臂动脉（BCA）动脉瘤是一种相当罕见的情况。大多数病例是由慢性动脉硬化改变引起的。创伤后BCA损伤仅偶尔遇到，穿通伤导致的完全血管夹层是主要致病机制。虽然钝性胸部挫伤后孤立的BCA创伤很少见，但头臂损伤合并主动脉病变似乎是仅次于主动脉的第二常见血管损伤部位。迄今为止，文献中记录的孤立钝性BCA创伤病例通常涉及动脉从主动脉弓完全撕脱或在主动脉起源附近完全破裂。我们报告一例车祸中受伤的女性发生创伤后BCA动脉瘤的孤立病例，该女性遭受钝性胸部创伤，仅内膜和中膜发生了近环周性的血管壁夹层，范围达大部分。结合文献描述并讨论了钝性胸部挫伤后BCA病变的临床特征、诊断方法、手术治疗及创伤机制。
