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1.
Zhonghua Wai Ke Za Zhi ; 58(2): 137-141, 2020 Feb 01.
Artigo em Chinês | MEDLINE | ID: mdl-32074814

RESUMO

Objective: To examine the outcomes of surgical treatment in patients of type Stanford A aortic dissection with Kommerell's diverticulum. Methods: From January 2009 to August 2017, patients of type Stanford A aortic dissection with Kommerell's diverticulum who underwent the Sun procedure were enrolled. Patient demographic, preoperative, intraoperative, early morbidity and mortality data were collected from medical and electronic patient records. Clinical follow-up data, including late morbidity and mortality, were obtained by telephone interview with the patient. Results: A total of 13 patients (11 males and 2 females; mean age 47 years) were included. The mean maximum diameter of Kommerell's diverticulum was (21.8±7.7) mm. The Kommerell's diverticulum was repaired by direct suture of the orifice in 3 patients, ligation of the aberrant right subclavian artery in 9 patients, and suture and ligation in 1 patient, respectively. No perioperative death occurred. One patient underwent a reexploration for bleeding. There were 2 late deaths: unknown reason in 1 patient and septic shock secondary to renal abscess in 1 patient. Reintervention was performed in one patient for a persistent type Ⅱ endoleak. Conclusions: The Sun procedure with femoral artery cannulation for cardiopulmonary bypass, unilateral carotid artery cannulation for selective cerebral perfusion and ligation of aberrant right subclavian artery on the right side of the trachea is an appropriate therapeutic strategy for patients of type Stanford A aortic dissection with Kommerell's diverticulum.


Assuntos
Aneurisma Dissecante , Divertículo , Aneurisma Dissecante/cirurgia , Aorta Torácica , Ponte Cardiopulmonar , Divertículo/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Subclávia
2.
J Cardiothorac Surg ; 15(1): 8, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31915025

RESUMO

BACKGROUND: Bleeding of the subclavian artery is a fatal condition. Adhesion between the pleura and staple line may develop after surgical treatment of pneumothorax, and collateral arteries often develop from the subclavian artery toward the adhesion at the lung apex; however, atraumatic tearing and bleeding of these collateral arteries into the extrapleural and intrathoracic cavities is rare. CASE PRESENTATION: A 70-year-old man visited the hospital for evaluation of left chest pain. Contrast-enhanced chest computed tomography showed a huge tumor in the left apex of the lung. It was suspected to be an extrapleural huge hematoma, and it ruptured into the thoracic cavity. Bleeding from the left subclavian artery was suspected; therefore, emergency angiography was performed. Angiography showed some collateral circulation from the left subclavian artery to the apex of the left lung. Distal and proximal bleeding points were identified. The distal bleeding point was embolized using coils. The proximal bleeding point was blown out, and stents were placed in the left subclavian artery. He had undergone pneumothorax surgery 20 years previously, and the present bleeding episode was strongly suspected to be associated with that surgery. The collateral circulation from the subclavian artery could have developed because of post-pneumothorax inflammation, eventually rupturing and bleeding into the extrapleural space. CONCLUSIONS: This report described an important case of atraumatic subclavian artery bleeding considered to have been caused by surgical treatment of pneumothorax 20 years previously. Emergency angiography and percutaneous stent placement or coil embolization should be considered first in such cases.


Assuntos
Embolização Terapêutica , Hematoma/etiologia , Hematoma/terapia , Pneumotórax/cirurgia , Artéria Subclávia , Aderências Teciduais/complicações , Idoso , Angiografia , Circulação Colateral , Hematoma/diagnóstico por imagem , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia
3.
J Cardiothorac Surg ; 15(1): 12, 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31924238

RESUMO

BACKGROUND: Mediastinal hematoma rarely occurs after a minor traffic injury. CASE PRESENTATION: A woman in her forties was transferred to the emergency room by ambulance due to a traffic accident. Computed tomography (CT) revealed no abnormal findings, and she went home. Two days after the accident, the contrast-enhanced CT was repeated, which revealed cervical and mediastinal hematomas. Because it was possible that there was active bleeding from the right inferior thyroid artery, embolization of the right inferior thyroid artery was performed; however, her condition further deteriorated, so we performed emergency surgery to achieve hemostasis and remove the hematoma. Because of oozing from the right thyroid lobe, we performed right hemithyroidectomy and drainage of mediastinal space and right thoracic cavity. Since there was no bleeding site in the mediastinum, we thought that the mediastinal hematoma was due to bleeding from the thyroid gland. Her postoperative course was uneventful, and she is doing well at 9 months of follow-up after surgery. CONCLUSIONS: It is possible that mediastinal hematoma might be caused by a minor traffic injury.


Assuntos
Acidentes de Trânsito , Hematoma/etiologia , Hemorragia/etiologia , Doenças do Mediastino/etiologia , Lesões do Pescoço/complicações , Doenças Faríngeas/etiologia , Glândula Tireoide/lesões , Adulto , Drenagem , Embolização Terapêutica/efeitos adversos , Feminino , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Hemorragia/diagnóstico por imagem , Hemorragia/cirurgia , Humanos , Doenças do Mediastino/diagnóstico por imagem , Doenças do Mediastino/cirurgia , Doenças Faríngeas/diagnóstico por imagem , Doenças Faríngeas/cirurgia , Artéria Subclávia , Doenças da Glândula Tireoide/diagnóstico por imagem , Doenças da Glândula Tireoide/etiologia , Doenças da Glândula Tireoide/cirurgia , Glândula Tireoide/irrigação sanguínea , Glândula Tireoide/cirurgia , Tomografia Computadorizada por Raios X
5.
Braz J Cardiovasc Surg ; 34(6): 769-771, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31793254

RESUMO

Aortic arch anomalies are not clinically important unless they cause compression symptoms due to aneurysmatic dilatation. Aortic anomalies need to be treated when they cause complex thoracic aortic diseases, and the treatment approach has evolved over time from open surgical methods, which have high mortality and morbidity rates, to hybrid methods. A case of a 68-year-old male patient with complex aortic arch anomaly treated with hybrid arch repair is reported in this study. Aortic branches were common carotid trunk and aberrant right subclavian artery with a saccular aneurysm.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Anormalidades Cardiovasculares/cirurgia , Artéria Subclávia/anormalidades , Procedimentos Cirúrgicos Vasculares/métodos , Idoso , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Anormalidades Cardiovasculares/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia
6.
J Cardiothorac Surg ; 14(1): 201, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31771609

RESUMO

BACKGROUND: An aberrant right subclavian artery which arises from the proximal descending aorta may result in aortic dissection. The dissection may occur at either the site of the primary intimal tear or from an aortic branch. These conditions may lead to blood flow limitation and possible aneurysmal degeneration in the future. CASE PRESENTATION: We described the clinical presentation and management of a 54-year old patient diagnosed with a rare case of an aberrant right subclavian artery with Stanford Type B aortic dissection. A hybrid surgical approach was successfully performed and the patient had an uneventful recovery. CONCLUSION: Even though aortic dissection is often an incidental finding, this case highlighted that in rare situations, it can be associated with an aberrant right subclavian artery. It is important to disseminate this association as it has profound diagnostic and therapeutic implications in safeguarding the clinical outcomes of patients with such condition.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Anormalidades Cardiovasculares/cirurgia , Artéria Subclávia/anormalidades , Procedimentos Cirúrgicos Vasculares/métodos , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico , Anormalidades Cardiovasculares/complicações , Anormalidades Cardiovasculares/diagnóstico , Angiografia por Tomografia Computadorizada , Humanos , Imageamento Tridimensional , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Artéria Subclávia/cirurgia
7.
Medicine (Baltimore) ; 98(47): e17829, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764776

RESUMO

RATIONALE: Venous thoracic outlet syndrome (VTOS) secondary to subclavian arterial stent implantation is extremely rare. Here, we firstly report this disease and the endovascular intervention using covered-stents. PATIENT CONCERNS: An 80-year-old man who had received an acceptable stent implantation for the treatment of a right subclavian arteriovenous malformation (AVM), presented with a gradually increasing swelling and pain in his right upper extremity. DIAGNOSIS: The patient was diagnosed with right VTOS and recurrent subclavian AVM following ultrasonography and computed tomographic angiography. INTERVENTIONS: We positioned a covered-stent in the subclavian artery to block the feeding arteries and successfully embolized the remaining branches with coils. Next, we performed successful dilation 3 times, followed by the positioning of another covered-stent in the right subclavian vein. OUTCOMES: The patient was free of all symptoms and the imaging procedures confirmed an acceptable thrombosis of the AVM with patent stents in the right subclavian artery and vein during the 6-month follow-up. LESSONS: Venous stent implantation is an alternative to treat VTOS caused by subclavian arterial stents and it is essential to pay more attention to the incidence of VTOS following arterial stent implantation in the subclavian artery.


Assuntos
Complicações Pós-Operatórias/etiologia , Stents/efeitos adversos , Artéria Subclávia , Síndrome do Desfiladeiro Torácico/etiologia , Idoso de 80 Anos ou mais , Humanos , Masculino
8.
Kyobu Geka ; 72(12): 1019-1022, 2019 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-31701915

RESUMO

A 67-year-old woman encountered a traffic accident and had chest computed tomography(CT) examination. It revealed a 24 mm Kommerell's diverticulum associated with a right-sided aortic arch and a 15 mm saccular aneurysm of an aberrant left subclavian artery. We performed intra-aneurysmal coil embolization for the left subclavian artery aneurysm after a balloon occlusion test of the left subclavian artery. The postoperative course was uneventful.


Assuntos
Aneurisma , Divertículo , Idoso , Aneurisma/complicações , Aorta Torácica , Anormalidades Cardiovasculares , Divertículo/complicações , Feminino , Humanos , Artéria Subclávia/anormalidades
11.
Am J Case Rep ; 20: 1509-1514, 2019 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-31607743

RESUMO

BACKGROUND Subclavian stenosis is an uncommon clinical condition associated with severe cardiovascular complications, usually presenting with claudication and subclavian steal syndrome. Here we describe the rare case of bilateral subclavian artery stenosis in an asymptomatic patient. CASE REPORT Our patient was a 63-year-old chronic smoker with no prior medical history whose chief complaint was dyspnea from an exacerbation of his chronic obstructive pulmonary disease (COPD). He was hypotensive with blood pressure 74/56 mmHg at admission, which raised suspicion for sepsis, adrenal insufficiency but the workup (renal panel, full blood count and synacthen tests) were normal. He quickly recovered after we treated his COPD exacerbation, but his hypotension persisted despite repeated fluid challenges. To evaluate for structural causes of his hypotension, we performed a full cardiovascular examination with 4 limb blood pressure measurements and found upper limb hypotension and lower limb hypertension. Subsequent imaging with ultrasound and computed tomography confirmed the presence of bilateral subclavian artery stenosis. Our diagnosis was thus bilateral subclavian artery stenosis secondary to atherosclerosis from chronic smoking. The patient was subsequently referred to vascular surgery for consideration of surgical revascularization. CONCLUSIONS Bilateral subclavian stenosis is extremely rare and requires a high index of clinical suspicion. Early diagnosis is important in the primary prevention of associated cardiovascular diseases.


Assuntos
Hipotensão/etiologia , Síndrome do Roubo Subclávio/diagnóstico por imagem , Doenças Assintomáticas , Aterosclerose/complicações , Angiografia por Tomografia Computadorizada , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Fumantes , Artéria Subclávia/diagnóstico por imagem , Ultrassonografia Doppler Dupla , Artéria Vertebral/diagnóstico por imagem
12.
Kyobu Geka ; 72(11): 914-917, 2019 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-31588108

RESUMO

A 52-year-old man with a history of von Recklinghausen's disease presented to our hospital with abrupt onset of right chest and back pain. A contrast-enhanced chest computed tomography (CT) revealed massive right hemothorax, extravasation of the contrast medium at a branch of the right subclavian artery, and a tumor surrounding the second right dorsal rib. Based on findings from emergent angiography, hemothorax secondary to the rupture of an aneurysm of a branch of the right subclavian artery was diagnosed, and transcatheter arterial embolization(TAE) was performed. After hemostasis, intrathoracic hematoma was removed by surgery, and a recurrence of hemothorax did not occur until at least 8 months after the initial TAE procedure.


Assuntos
Aneurisma , Neurofibromatose 1 , Hemotórax , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Artéria Subclávia
14.
Cardiovasc Intervent Radiol ; 42(12): 1786-1794, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31555850

RESUMO

PURPOSE: It has been hypothesized that microstents which are used to prevent coil protrusion in the treatment of cerebral aneurysms may have flow diverting and therefore occlusive effects. In a rabbit elastase aneurysm model, we investigated the aneurysm occlusion rate and vessel reaction of a braided Accero stent prototype with porosity in the lower range of other available (non-flow-diverter) microstents. METHODS: Ten aneurysms were induced the right subclavian artery in New Zealand white rabbits and treated with the Accero stent prototype. In each subject, a second stent was implanted in the abdominal aorta to cover the origins of branch arteries. Angiographic follow-up and explantation of the devices and aneurysms for histological analysis were performed after 3 months (n = 5) and 6 months (n = 5). RESULTS: Grades I (< 50%) and II (> 50%) occlusion rates were observed in 9 (90%) and 1 (10%) of ten aneurysms treated with the stent device. The mean reduction in contrast filling at 6 months was 42.1% (p = .02). Neointima thickness was significantly higher in the subclavian artery than in the abdominal aorta after 3 (p = .03), whereas not after 6 months (p = .1). No cases of inadequate wall apposition, branch artery occlusion or stent thrombosis were observed. CONCLUSION: The present study showed flow remodelling properties of the device prototype with progredient aneurysm occlusion. A larger in vivo study with induced aneurysm should be done to confirm these results.


Assuntos
Aneurisma Aórtico/terapia , Stents , Grau de Desobstrução Vascular/fisiologia , Angiografia , Animais , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/fisiopatologia , Modelos Animais de Doenças , Desenho de Equipamento , Feminino , Coelhos , Artéria Subclávia/diagnóstico por imagem , Resultado do Tratamento
15.
J Assoc Physicians India ; 67(7): 74-76, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31559776

RESUMO

We diagnosed a case of Takayasu arteritis (TA) involving subclavian arteries, the aorta, superior mesenteric artery and renal arteries presenting with stenotic, occlusive, and aneurysmal lesions along with mural thrombus, which responded well to ATD and steroids. We report this case as a rare combination of vascular lesions in a patient with a relatively rare variant of TA.


Assuntos
Arterite de Takayasu , Aorta , Constrição Patológica , Humanos , Artéria Renal , Artéria Subclávia
18.
Cardiol Young ; 29(10): 1302-1304, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31475651

RESUMO

A new approach was used in the percutaneous treatment of two patients with severe recoarctation involving the origin of the left subclavian artery. A tiny handmade fenestration was created in a NuMED-covered Cheatham-platinum stent before its implantation to avoid left subclavian artery occlusion. The stent placement was performed using a two-guidewire technique in which the different stiffness helped a proper positioning of the stent. After the stent deployment, the fenestration was enlarged performing a balloon angioplasty to improve flow in left subclavian artery.


Assuntos
Aorta Torácica/cirurgia , Coartação Aórtica/cirurgia , Implante de Prótese Vascular/métodos , Materiais Revestidos Biocompatíveis , Platina , Artéria Subclávia/cirurgia , Adulto , Coartação Aórtica/diagnóstico , Aortografia/métodos , Criança , Feminino , Humanos , Masculino , Desenho de Prótese
19.
World J Pediatr Congenit Heart Surg ; 10(5): 654-656, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31496408

RESUMO

We present the case of a neonate born with an unusual complex vascular ring formed by a left-sided aortic arch that had retroesophageal course to join a right-sided descending aorta and a very large right-sided arterial ductus from the right pulmonary artery to the descending aorta. Associated finings included aortic arch hypoplasia, aberrant right subclavian artery, and aberrant origin of the left pulmonary artery from the aorta. We focus on the role of computed tomography angiography in the preoperative and postoperative assessment of this complex anomaly.


Assuntos
Angiografia por Tomografia Computadorizada , Pneumopatias/diagnóstico por imagem , Anel Vascular/diagnóstico por imagem , Angiografia , Aorta/diagnóstico por imagem , Aorta Torácica/anormalidades , Anormalidades Cardiovasculares/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , Artéria Subclávia/anormalidades , Artéria Subclávia/diagnóstico por imagem , Tomografia Computadorizada por Raios X
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