ABSTRACT
Thoracic outlet syndrome (TOS) refers to the compression of the neurovascular bundle within the thoracic outlet. Cases are classified by primary etiology-arterial, neurogenic, or venous. In addition to the typical symptoms of arm swelling and paresthesias, headaches have been reported as a potential symptom of TOS. In this report, we describe a patient with debilitating migraines, which were consistently preceded by unilateral arm swelling. Resolution of symptoms occurred only after thoracic outlet decompression. Patients with migraines and concomitant swelling and/or paresthesias, especially related to provocative arm maneuvers, should be considered a possible atypical presentation of TOS and evaluated in more detail.
Subject(s)
Migraine Disorders/etiology , Thoracic Outlet Syndrome/complications , Upper Extremity/blood supply , Adult , Cerebrovascular Circulation , Decompression, Surgical/methods , Hemodynamics , Humans , Male , Migraine Disorders/diagnosis , Migraine Disorders/physiopathology , Phlebography , Regional Blood Flow , Thoracic Outlet Syndrome/diagnosis , Thoracic Outlet Syndrome/physiopathology , Thoracic Outlet Syndrome/surgery , Treatment OutcomeABSTRACT
Enlarging aneurysms in the thoracic aorta frequently remain asymptomatic. Fistulization of thoracic aortic aneurysms (TAA) to adjacent structures or the presence of a patent ductus arteriosus and TAA may lead to irreversible cardiopulmonary sequelae. This article reports on a large aneurysm of the thoracic aorta with communication to the pulmonary artery causing pulmonary edema and cardiorespiratory failure. The communication was ultimately closed after thoracic endovascular aortic aneurysm repair allowing rapid symptom resolution. Early diagnosis and closure of such communication in the presence of TAA are critical for prevention of permanent cardiopulmonary damage.
Subject(s)
Aortic Aneurysm, Thoracic/complications , Arterio-Arterial Fistula/etiology , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Pulmonary Artery , Pulmonary Edema/etiology , Aged , Aortic Aneurysm, Thoracic/diagnosis , Aortic Aneurysm, Thoracic/surgery , Arterio-Arterial Fistula/diagnosis , Arterio-Arterial Fistula/surgery , Humans , Male , Pulmonary Edema/diagnosis , Pulmonary Edema/surgeryABSTRACT
Thoracic aortic aneurysm is a rare condition that carries a critical risk of rupture and mortality. These risks are increased during pregnancy because of a progressively hyperdynamic pattern of circulation. Simultaneously, pregnancy-imposed limitations on the use of ionized radiation and intravenous contrast agents may render conventional techniques for imaging and repair confirmation less acceptable. We describe a novel approach to intraoperative management of an endovascular repair for symptomatic thoracic saccular aneurysm in a pregnant patient, based on intravascular ultrasound and transesophageal echocardiography, with maintenance of uterine perfusion. The patient recovered well and proceeded to a normal delivery. Despite a favorable outcome in this case, further studies of perioperative management of aortic disease in pregnancy are needed.
Subject(s)
Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation , Pregnancy Complications, Cardiovascular/surgery , Adult , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/physiopathology , Aortography/methods , Contrast Media/adverse effects , Echocardiography, Transesophageal , Endovascular Procedures , Female , Gestational Age , Hemodynamics , Humans , Magnetic Resonance Angiography , Predictive Value of Tests , Pregnancy , Pregnancy Complications, Cardiovascular/diagnostic imaging , Pregnancy Complications, Cardiovascular/physiopathology , Radiation Dosage , Radiography, Interventional/adverse effects , Tomography, X-Ray Computed , Treatment Outcome , Ultrasonography, Interventional , Ultrasonography, PrenatalABSTRACT
A 70-year-old man presented with a contained aortic rupture above the aortic bifurcation in the setting of a chronic type B aortic dissection. The celiac and right iliac arteries were supplied by the false lumen, and the superior mesenteric, left iliac, and bilateral renal arteries were supplied by the true lumen. An open repair was not possible due to right-sided heart failure. The "cheese wire" maneuver is a technique used to fenestrate an intimal flap, alleviating malperfusion in aortic dissection. In our modification, a Glidewire (Terumo Medical, Somerset, NJ) was passed across the intimal flap using a Ross Modified Colapinto needle (Cook Medical, Bloomington, Ind) and pulled downward to shear through the membrane to the aortic bifurcation. The fenestration was followed by a unibody endograft stent repair across the contained rupture.