Eur J Cardiothorac Surg 2006;30:672
© 2006 Elsevier Science NL
Images in cardio-thoracic surgery |
Post-aortic left innominate vein with aortic arch aneurysm
Yoshitsugu Nakamura*,
Kiyoharu Nakano,
Hayao Nakatani
Department of Cardiovascular Surgery, Kanto Medical Center NTT EC, 5-9-22 Higashigotanda, Shinagawa-ku, Tokyo 141-8625, Japan
Received 30 June 2006;
received in revised form 13 July 2006;
accepted 19 July 2006.
* Corresponding author. Tel.: +81 3 3448 6565; fax: +81 3 3448 6566. (Email: nakamura{at}kmc.mhc.east.ntt.co.jp).
Key Words: Anatomy • Aneurysm • Aortic • Aortic arch • Vascular disease • Venous disease • Vascular abnormality • Veins
Post-aortic left innominate vein (PALIV) is a rare abnormality passing over the aortic arch. A 70-year-old male was diagnosed with PALIV and distal aortic arch aneurysm (Fig. 1
). Total arch replacement was successfully performed using antegrade selective cerebral perfusion of 20 °C. PALIV was preserved by complete exposure and retraction (Fig. 2
).
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Fig. 1. Three-dimensional CT: (A) post-aortic left innominate vein (PALIV) and a distal aortic arch aneurysm of 65 mm. PALIV passed in front of the aneurysm, below the aortic arch, and behind the ascending aorta before entering the superior vena cava at the junction with the right atrium.
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Fig. 2. Intraoperative surgeon's view: (A) post-aortic left innominate vein (PALIV) (*) located on the anterior surface of the distal aortic arch aneurysm (An) along the left vagus nerve (arrow), passing in front of the ligamentum arteriosum. (B: after graft replacement) A 26-mm quadrifurcated graft was used for graft replacement. No division of PALIV was required.
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