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Objective To evaluate the effect of surgical treatment on extracranial supra-aortic aneurysms and summarize the experience.Methods The clinical data of 10 patients undergoing surgical treatment of extracranial supra-aortic aneurysms from May 2019 to November 2023 in the Department of Vascular Surgery of Beijing Tiantan Hospital affiliated to Capital Medical University were collected.The 10 patients included 5 patients with internal carotid artery aneurysm,2 patients with subclavian artery aneurysm,2 patients with vertebral artery aneurysm,and 1 patient with internal carotid artery aneurysm combined with ipsilateral subclavian artery aneurysm.The surgical indications,surgical regimens,clinical efficacy,and complications were retrospectively analyzed. Results All the 10 patients underwent surgery successfully,with the surgery duration range of 60-420 min and the median surgery duration of 180.0 (121.5,307.5) min.Intraoperative bleeding volume varied within 30-400 mL,with a median of 90 (50,125) mL.The time of carotid artery blocking and vertebral artery blocking varied within the ranges of 10-20 min and 20-30 min,with the medians of 15.0 (11.5,16.3) min and 25.0 (15.0,22.5) min,respectively.No cardiac accident,cerebral infarction,or cerebral hemorrhage occurred during the perioperative period.The 10 patients were followed up for 3-58 months,with the median follow-up time of 8.5 (5.3,17.0) months.One patient with subclavian artery aneurysm developed artificial vessel occlusion 20 months after surgery.One patient with internal carotid artery aneurysm developed distal carotid artery stenosis 6 months after surgery. Conclusion Surgical treatment should be actively adopted for extracranial supra-aortic aneurysms,and individualized surgical regimens should be designed according to patient conditions.
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An LSCA aneurysm is a rare disease. When and how to operate are debated. While open surgery was initially considered the sole option, emerging endovascular techniques have been described. The present report describes a novel hybrid technique to treat an LSCA aneurysm combined to a proximal descending aneurysm in a young 25-year-old patient.
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Aneurisma da Aorta Torácica , Aneurisma Aórtico , Implante de Prótese Vascular , Procedimentos Endovasculares , Humanos , Adulto , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Stents , Implante de Prótese Vascular/métodos , Aorta Torácica/cirurgia , Prótese Vascular , Procedimentos Endovasculares/métodos , Aneurisma Aórtico/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgiaRESUMO
This case highlights the unusual life-threatening findings found in a patient with Marfan syndrome (MFS) in the emergency department setting. MFS is a rare autosomal dominant disease that affects 1 in 3000-5000 individuals and has a highly variable range of clinical severity. This case is a 63-year-old male with COPD, scoliosis, aortic and mitral valve replacements on warfarin, and MFS who presented with acute onset hemoptysis, tachypnea, and oxygen saturation of 77% on 4 l nasal cannula. Emergent chest computed tomography angiography (CTA) revealed both a contained rupture of a left subclavian artery aneurysm and active extravasation from his left internal mammary artery (LIMA) into his left chest. The patient was on warfarin and reversed with IV vitamin K and prothrombin complex concentrate. Vascular surgery emergently took the patient to the operating room for embolization of his LIMA and stenting of the contained ruptured left subclavian artery aneurysm. The patient was discharged home one month after admission. This case report illustrates the potential severe sequelae of MFS and the importance of rapid recognition by emergency physicians. An expanded understanding of the pathophysiology of MFS has resulted in great advancement in medical therapies and lifestyle modification and thus has significantly prolonged life expectancy in these patients. Increased awareness and familiarity will facilitate continued high-quality management and treatment by emergency physicians.
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Aneurisma Roto/diagnóstico , Síndrome de Marfan/complicações , Aneurisma Roto/etiologia , Aneurisma Roto/cirurgia , Angiografia por Tomografia Computadorizada , Hemoptise/etiologia , Humanos , Masculino , Artéria Torácica Interna/diagnóstico por imagem , Síndrome de Marfan/fisiopatologia , Síndrome de Marfan/terapia , Pessoa de Meia-Idade , Artéria Subclávia/diagnóstico por imagemRESUMO
The article deals with the relevant literature data concerning diagnosis and treatment of subclavian artery aneurysms. This nosological entity is relatively uncommon, however its importance for modern medicine should not be underestimated. Despite a low incidence of the pathology, it should be understood that the disease's course for the patient is associated with the development of severe complications which may lead to disability or even death. The development of complications is extremely difficult to predict and stratification of risks for such patients is too complicated. It is also known that the diagnosis of a subclavian artery aneurysm is frequently an accidental finding, since the pathology may for a long time proceed symptom-free. At the same time, the subclavian artery occupies the first place by the frequency of localization of upper-limb aneurysms, thus making this problem currently important. Besides, separate attention should be paid to modern methods of correction of this disease, since implementation of high-tech interventions into vascular surgery have significantly expanded the arsenal of the operating surgeon.
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Aneurisma , Cirurgiões , Aneurisma/diagnóstico , Aneurisma/etiologia , Aneurisma/cirurgia , Humanos , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Extremidade SuperiorRESUMO
OBJECTIVE: Little is known about the natural history and management of aneurysmal aortic arch branch vessels (AABVs). The objectives of this study were to assess the natural history of aneurysmal AABVs and to examine the outcomes of operative intervention. METHODS: A retrospective review of the Yale radiologic database from 1999 to 2016 was performed. Only those patients with an aneurysmal AABV and a computed tomography scan were selected for review. Patients' demographics, aneurysm characteristics, management, and follow-up information were collected. RESULTS: There were 105 patients with 147 aneurysmal AABVs; 76 were male (72%), with a mean age of 70 years (range, 17-93 years). We identified 63 innominate, 50 left subclavian, 30 right subclavian, and 4 common carotid artery aneurysms. On computed tomography, 65 (62%) had aortic aneurysms and six (6%) had suffered an aortic dissection. Most were asymptomatic (104 [99%]); one had chest pain and an enlarging swollen mass. Twelve (11%) patients underwent operative repair (OR) for 12 aneurysmal AABVs because of symptoms, growth, or concomitant aortic operations; 93 (89%) were observed in the no operative repair (NOR) group with cross-sectional imaging. The overall mean vessel diameter was 2.08 ± 0.68 cm. The mean diameters in the OR and NOR groups were 3.32 ± 1.24 cm and 1.97 ± 0.46 cm, respectively (P = .002). OR included nine bypasses with resection, two stent grafts, and one resection without reconstruction. Two patients developed postoperative hemorrhage requiring re-exploration, one patient developed stent thrombosis, and one patient required pseudoaneurysm repair 20 years after index operation. Mean follow-up was 52 ± 51 months for the NOR group, with no ruptures or emboli. The growth rate was 0.04 ± 0.10 cm/y. On multivariable regression analysis, a descending aortic aneurysm (P = .041) and a left subclavian artery aneurysm (P = .016) were associated with higher growth rates, whereas height was associated with a lower growth rate (P = .001). CONCLUSIONS: Aneurysmal AABVs tend to have a benign natural history with slow growth rates and low rates of complications, including rupture and embolization. We recommend expectant observational management for small, incidentally detected aneurysms.
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Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Centros de Atenção Terciária , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/fisiopatologia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/fisiopatologia , Aortografia/métodos , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Tomada de Decisão Clínica , Angiografia por Tomografia Computadorizada , Connecticut , Bases de Dados Factuais , Progressão da Doença , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento , Conduta Expectante , Adulto JovemRESUMO
Interrupted aortic arch is a very rare but well-described congenital anomaly. Concomitant presentation of interrupted aortic arch and giant subclavian artery aneurysm is an unusual event in adulthood. To the best of our knowledge, hybrid intervention for type A aortic arch interruption with a giant aneurysm of the subclavian artery is an alternative approach for the management of these concomitant pathologies in adults.
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Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Aorta Torácica/anormalidades , Coartação Aórtica/diagnóstico por imagem , Coartação Aórtica/cirurgia , Artéria Subclávia/anormalidades , Implante de Prótese Vascular , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Adulto JovemRESUMO
This report describes the case of a frail 36-year-old patient who underwent an endovascular treatment of a right subclavian artery pseudoaneurysm (SAP) associated with an arteriovenous fistula secondary to a traumatic central venous catheter insertion. The deployment of a covered stent from the innominate to the right common carotid artery combined with coiling of the SAP and the internal mammary artery was performed. Two additional covered stents were deployed from the vertebral artery to the distal subclavian artery to preserve right upper extremity circulation. This case highlights the feasibility of an endovascular treatment of a complex SAP in a candidate unsuitable for open surgery.
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Right-sided subclavian artery aneurysms (SAAs) are exceedingly rare. The most common cause of intrathoracic SAAs is atherosclerosis; however, causes can also include infection, trauma, cystic medial degeneration, Marfan syndrome, and Takayasu arteritis. Symptoms present most commonly with compression of surrounding structures, although adverse events, including rupture, thrombosis, and embolization, can also occur. We present a case of a 30-year-old woman with an asymptomatic, 15-mm, right-sided SAA, which was successfully resected with subsequent end-to-end primary anastomosis.
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Subclavian artery aneurysms, occasionally related to connective tissue diseases, including Marfan syndrome, are rare and conventionally managed with surgery or endovascular treatment. However, in some cases, both interventions are challenging because of the inability to reach an aneurysm through a safe route or postoperative adhesion. This report describes the case of a 43-year-old patient with a left subclavian artery aneurysm and Marfan syndrome. In this case, the patient's 5 previous surgeries related to Marfan syndrome made surgery and endovascular treatment difficult. Therefore, an alternative was researched, and we decided to perform a method of percutaneous embolization with coils and N-butyl cyanoacrylate using the direct puncture technique, which succeeded in eliminating the blood flow in the left subclavian artery aneurysm. No severe complications were associated with the procedure. The patient was free from the risk of an aneurysm rupture post-treatment, and the left back pain improved. Follow-up computed tomography 2 years postsurgery revealed the aneurysm being under control without re-enlarging. Our method is considered an effective and safe therapeutic option for cases in which surgical approach and transarterial access routes are limited.
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Surgical repair of a subclavian artery mycotic aneurysm is dependent on aneurysm-specific characteristics and anatomic exposures could require sternotomy, thoracotomy, or supraclavicular incisions. Alternatively, a median claviculectomy can be used. We successfully performed a subclavian artery to axillary artery bypass with median claviculectomy in a 23-year-old man with multiple comorbidities. Postoperative Doppler ultrasound showed a patent left axillary artery with a palpable left radial artery, and the patient demonstrated full left shoulder range of motion without any significant deformities. This case suggests that a median claviculectomy can produce satisfactory outcomes in patients with subclavian artery mycotic aneurysms.
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Treatment of an aberrant right subclavian artery (arteria lusoria) aneurysm is traditionally performed surgically or via a hybrid approach. To our knowledge, a fully percutaneous approach has not yet been reported. We describe the fully endovascular exclusion of an aberrant right subclavian artery and thoracic aortic aneurysm. This approach has the potential advantage of avoiding complications of an open surgical repair, particularly in patients of advanced age and/or with multiple comorbidities.
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Aneurisma/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Anormalidades Cardiovasculares/cirurgia , Transtornos de Deglutição/cirurgia , Divertículo/patologia , Artéria Subclávia/anormalidades , Idoso de 80 Anos ou mais , Angiografia/métodos , Aorta Torácica/patologia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico , Anormalidades Cardiovasculares/complicações , Anormalidades Cardiovasculares/patologia , Divertículo/cirurgia , Humanos , Masculino , Artéria Subclávia/cirurgia , Tomografia/métodos , Resultado do TratamentoRESUMO
Loeys-Dietz syndrome (LDS) is a rare connective tissue disorder. Vessel tortuosity and aneurysms throughout the vasculature are unique to LDS. Aortic root enlargement is ubiquitous, with most patients undergoing root replacement at some point in their lifetime. Multiple vascular procedures are required to prolong life expectancy. We describe a staged hybrid approach to a 17-year-old patient with LDS presenting with ascending aorta, arch, and bilateral subclavian artery aneurysms and prominent tortuosity. Transposition of the left vertebral and subclavian arteries onto the common carotid artery was performed. Total aortic arch replacement with frozen elephant trunk extension into the descending thoracic aorta was performed as a second stage. Bilateral subclavian artery aneurysms were excluded with the use of a four-branched graft.
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This manuscript describes an endovascular repair of a symptomatic, large proximal left subclavian artery aneurysm in a patient with dextrocardia and right-sided aortic arch and absent bilateral internal carotid arteries. The patient had surgical reconstruction as an infant for congenital heart disease with Ventricular Septal Defect, bifid sternum . Given her previous surgical history, we declined an open operation and performed an endovascular repair with stent grafts to successfully repair the subclavian artery aneurysm. The patient had an uneventful postoperative course and follow-up ultrasonography demonstrated successful repair with preservation of flow through the left subclavian and vertebral arteries with resolution of her symptoms.
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Aneurisma , Aneurisma da Aorta Torácica , Dextrocardia , Procedimentos Endovasculares , Humanos , Feminino , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Artéria Subclávia/anormalidades , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Resultado do Tratamento , Aneurisma/complicações , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Dextrocardia/complicações , Dextrocardia/diagnóstico por imagemRESUMO
True intrathoracic subclavian artery aneurysms (SCAAs) are rare and have various etiologies. Right intrathoracic SCAAs pose specific anatomic challenges to repair. We present three different operative approaches, open, endovascular, and hybrid repair, for the repair of a right intrathoracic SCAA in three patients with genetic arteriopathy: Marfan syndrome, vascular Ehlers-Danlos syndrome, and unspecified Ehlers-Danlos syndrome, respectively. These cases demonstrate an individualized operative approach based on the genetic diagnosis for each patient presenting with a right intrathoracic SCAA.
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Subclavian artery aneurysms are rare peripheral artery aneurysms, and open surgical repair is the reference standard treatment. We have reported the case a patient with a right subclavian artery aneurysm who was not indicated for open surgical repair because of comorbidities. Thus, endovascular treatment using the Gore Excluder Iliac Branch Endoprosthesis (WL Gore and Associates, Flagstaff, Ariz) was performed, leading to complete aneurysmal exclusion without perioperative complications. Although anatomic limitations exist, this technique could be alternative treatment option for right subclavian artery aneurysms.
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Endovascular repair for brachiocephalic artery aneurysms (BAAs) and subclavian artery aneurysms (SAAs) is often unclear. We treated 2 such cases percutaneously with covered stents. It may be an alternative to surgical repair for patients with isolated BAA or SAA. (Level of Difficulty: Advanced.).
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Subclavian artery aneurysms are rare, but they are frequently responsible for limb or life-threatening complications. The clinical presentation, as supraclavicular mass to rupture, has been reported in literature, with management strategies being endovascular intervention to open conventional surgery. We report a case of giant subclavian artery aneurysm measuring 10 cm × 12 cm, which presented with a large anterior chest wall lump and massive bleed to our emergency department. We successfully treated this patient by ligating the aneurysm and evacuating the chest wall haematoma.
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Aneurisma , Artéria Subclávia , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Humanos , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgiaRESUMO
Here we present a 47-year-old male diagnosed with a pseudocoarctation of the aorta and a funnel-like subclavian artery aneurysm with a large orifice and severe aortic valve insufficiency. The patient underwent a two-stage repair for both pathologies. After an aortic valve replacement, postcardiotomy pericardial effusion occurred and was medically managed. Six months later, the patient underwent a distal arcus aorta and subclavian artery replacement with a left posterolateral thoracotomy as the second stage. Due to the strict adhesions, pulmonary veins were not cannulated and an extracorporeal bypass between the pulmonary artery and femoral artery was used for distal body perfusion. The coincidence of subclavian aneurysms and a pseudocoarctation of the aorta is rare and a literature review was performed to identify treatment options for this pathology.
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Aneurisma , Aneurisma da Aorta Torácica , Coartação Aórtica , Aneurisma/complicações , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Aorta , Aorta Torácica , Coartação Aórtica/complicações , Coartação Aórtica/diagnóstico por imagem , Coartação Aórtica/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Resultado do TratamentoRESUMO
INTRODUCTION AND IMPORTANCE: Kommerell diverticulum is a very rare congenital defect of the aortic arch associated with the aberrant subclavian artery. It can present with signs of dysphagia, chest pain, or distal embolization in the upper limb. CASE PRESENTATION: We present a case of Kommerell diverticulum with associated large subclavian artery aneurysm in a male patient with chest pain of unknown origin and hypertension. There was an incidental finding of the wide mediastinum on chest X-ray and the patient had a difference in systolic blood pressure in both arms. A right thoracotomy incision was used to successfully excise the aneurysm and reconstruct the subclavian artery. Patient recovery was uneventful. CLINICAL DISCUSSION: Endovascular approaches are also an alternative to conventional open surgeries in the treatment of Kommerell diverticulum. CONCLUSION: Kommerell diverticulum with subclavian artery aneurysm should be considered in the differential diagnosis of non-cardiac chest pain. A simple investigation such as a chest X-ray can make a difference in these patients. Coarctation related to the right ASA might not always be a true coarctation. Endovascular treatment is an alternative to open repair in selected cases, but it needs further investigation in large randomized control trials.
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Subclavian artery aneurysms (SAAs) are rare, and their repair can be technically complex. We have reported the redo repair of a large, expanding, right SAA after primary repair consisting of total aortic arch replacement with bilateral subclavian artery ligation and bypass. The redo repair used claviculectomy to facilitate exposure, ligation of the right deep cervical and internal thoracic arteries from within the aneurysm sac, and revision of the previous axillary artery bypass that had thrombosed owing to the mass effect of the expanding SAA. Claviculectomy can facilitate repair of large SAAs that are poorly suited to more routine exposure approaches, with acceptable risk and functional outcomes.