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1.
J Med Case Rep ; 15(1): 303, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34044882

RESUMO

BACKGROUND: This case report describes a subclavian vein cannulation that inadvertently led to an arterial puncture with the catheter tip radiologically seen at the level of the aorta. This case emphasizes the importance of postprocedural imaging and the disadvantages of not using ultrasound guidance in central venous catheterization. CASE PRESENTATION: A 24-year-old Caucasian man with diabetes mellitus type 1 presented himself to the emergency department due to abdominal pain accompanied by nausea and vomiting. The patient's vital signs revealed blood pressure of 84/53 mmHg, heart rate of 103 beats per minute, respiratory rate of 18 breaths per minute, and temperature of 98.2 °F (36.7 °C). On physical examination, he was found to have dry oral mucosa with poor skin turgor, with diagnostics showing that he was in diabetic ketoacidosis after running out of insulin for 2 days. The patient was transferred to the intensive care unit to receive a higher level of care. Unfortunately, due to difficulty of peripheral line placement, only a gauge-22 cannula was secured at the left dorsum of the hand. Efforts to replace the current peripheral line were unsuccessful, and a decision to perform a central vein cannulation via the internal jugular vein was made. This was futile as well due to volume depletion, prompting a subsequent right subclavian vein route attempt. The procedure inadvertently punctured the arterial circulation, leading to the catheter tip being visible at the level of the aorta on postprocedure X-ray. The subclavian line was immediately removed with no adverse consequences for the patient. A right femoral line was successfully placed, and continuous management of the diabetic ketoacidosis ensued until normalization of the high anion gap was achieved. CONCLUSION: Utilization of real-time ultrasound guidance via the subclavian approach could have allowed for direct visualization of needle insertion to the anatomical structures, guidewire location, and directionality, all of which can lead to decreased complications and improved cannulation success compared with the landmark technique. A leftward direction of the catheter seen on postprocedural X-rays should raise high suspicion of inadvertent catheter placement and immediate correction. This complication should have been prevented if ultrasound guidance had been used.


Assuntos
Cateterismo Venoso Central , Adulto , Aorta , Cateterismo Venoso Central/efeitos adversos , Humanos , Veias Jugulares , Masculino , Punções/efeitos adversos , Artéria Subclávia , Adulto Jovem
3.
BMC Neurol ; 21(1): 158, 2021 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-33853541

RESUMO

BACKGROUND: We present the case of a 75-year-old female with acute embolic cerebral infarction caused by a fail-implanted venous port catheter system in the left subclavian artery. CASE PRESENTATION: A 75-year-old woman presented to our emergency room after acute onset of a right-sided hemiparesis and dysarthria. Within 2 days after admission, she developed a left-sided hemiparesis, ataxia with concordant gait disturbance and incoordination of the left upper limb. DWI-MRI showed acute multiple infarcts in both cerebral and cerebellar hemispheres. Laboratory examination, 24-h Holter electrocardiography and transthoracic echocardiography provided no pathological findings. Further examination revealed an arterially fail-implanted port catheter, placed in the left subclavian artery with its tip overlying the ascending aorta, as the source of cerebral embolism. CONCLUSION: This is the first case report of thromboembolic, cerebral infarction due to a misplaced venous port catheter in the subclavian artery, emphasizing the imperative need for a thorough diagnostic workup, when embolism is suspected but cannot be proven at first glance.


Assuntos
Cateteres Venosos Centrais/efeitos adversos , Erros Médicos/efeitos adversos , Acidente Vascular Cerebral/etiologia , Artéria Subclávia , Idoso , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Embolia Intracraniana/etiologia
4.
BMC Surg ; 21(1): 193, 2021 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-33853567

RESUMO

BACKGROUND: Free flaps are widely used in maxillofacial reconstruction; however, this approach was not feasible in the current case. It was not possible because the free flap method requires microvascular anastomosis expertise, which is difficult, time-consuming and costly. CASE PRESENTATION: An 86-year-old woman suffered squamous cell carcinoma on the right side of her face, which resulted in a large soft-tissue defect. Here, we present a case of facial reconstruction from the inferior margin of the jaw to the top of the head. The size of the defect was 18.5 cm × 7.5 cm, which is rare for a patient of this age in the maxillofacial area. We used the supraclavicular artery island flap (SCAIFP) which measured 19.3 cm × 8.3 cm to repair the defect. After the operation, the flap survived without complications. Then, the patient was followed for 10 months and was satisfied with the aesthetic and functional results at the donor and recipient sites following the tumour resection. The tumour did not recur, and facial nerve function was preserved. CONCLUSION: Our results provide a new choice for the reconstruction of large defects of the head and face, and expand the potential applications of the SCAIFP.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Faciais , Procedimentos Cirúrgicos Reconstrutivos , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/cirurgia , Neoplasias Faciais/cirurgia , Feminino , Retalhos de Tecido Biológico , Humanos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Artéria Subclávia , Resultado do Tratamento
5.
J Card Surg ; 36(7): 2348-2354, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33855754

RESUMO

BACKGROUND: Query a single institution computed tomography (CT) database to assess the prevalence of aortic arch anomalies in general adult population and their potential association with thoracic aortopathies. METHODS: CT chest scan reports of patients aged 50-85 years old performed for any indication at a single health system between 2013 and 2016 were included in the analysis. Characteristics of patients with and without aortic arch anomalies were compared by t test and Fisher exact tests. Logistic regression analysis was performed to assess for independent risk factors of thoracic aortic aneurysm (TAA). RESULTS: Of 21,336 CT scans, 603 (2.8%) described arch anomalies. Bovine arch (n = 354, 58.7%) was the most common diagnosis. Patients with arch anomalies were more likely to be female (p < .001), non-Caucasian(p < .001), and hypertensive (p < .001). Prevalence of TAA in arch anomalies group was 10.8% (n = 65) compared to 4.1% (n = 844) in the nonarch anomaly cohort (p < .001). The highest prevalence of thoracic aneurysm was associated with right-sided arch combined with aberrant left subclavian configuration (33%), followed by bovine arch (13%), and aberrant right subclavian artery (8.2%). On binary logistic regression, arch anomaly (OR = 2.85 [2.16-3.75]), aortic valve pathology (OR 2.93 [2.31-3.73]), male sex (OR 2.38 [2.01-2.80]), and hypertension (OR 1.47 [1.25-1.73]) were significantly associated with increased risk of thoracic aneurysm disease. CONCLUSIONS: Reported prevalence of aortic arch anomalies by CT imaging in the older adult population is approximately 3%, with high association of TAA (OR = 2.85) incidence in this subgroup. This may warrant a more tailored surveillance strategy for aneurysm disease in this subpopulation.


Assuntos
Aneurisma , Aneurisma da Aorta Torácica , Anormalidades Cardiovasculares , Idoso , Idoso de 80 Anos ou mais , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Subclávia
6.
J Med Case Rep ; 15(1): 168, 2021 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-33853688

RESUMO

BACKGROUND: Thoracic endovascular aortic repair (TEVAR) is the gold standard for surgical management of descending thoracic aortic pathology. Depending on the anatomy, TEVAR often requires deployment across the origin of the left subclavian artery (LSA) to obtain a proximal seal, thus potentially compromising perfusion to the left upper extremity (LUE). However, in most patients this is generally well tolerated without revascularization due to collateralization from the left vertebral artery (LVA). CASE PRESENTATION: We present a complex 59-year-old Caucasian patient case of TEVAR with a history of prior arch debranching and intraoperative LSA coverage requiring subsequent LSA embolization and emergency take-back for left carotid-subclavian bypass. CONCLUSION: The purpose of this case report is to highlight an often overlooked anatomic LVA variant and an atypical, delayed presentation of acute LUE limb ischemia.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Doenças da Aorta , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Braço , Humanos , Isquemia , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Resultado do Tratamento
7.
Medicine (Baltimore) ; 100(9): e25043, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655982

RESUMO

RATIONALE: Anatomical variations in aortic arch (AA) branching are not unusual. Generally, these variations are asymptomatic and are diagnosed incidentally. Here, we report a rare case of a middle-aged female patient with an aberrant right subclavian artery (ARSA) associated with anomalous origins of the bilateral vertebral arteries (VAs). PATIENT CONCERNS: The patient treated for urolithiasis complained of repeated dizziness for several years. DIAGNOSES: Echocardiography and computed tomography angiography (CTA) confirmed arterial variations. Moreover, mild stenosis was found in the left common carotid artery (LCCA), which was considered to be the cause of dizziness. INTERVENTIONS: Congenital anomalous arteries were not necessary to intervene urgently, but aspirin and atorvastatin were administered to prevent potential thrombosis attributed to vascular stenosis after completing the operation for urolithiasis. OUTCOMES: Whether the symptoms will be alleviated or not should be continuously followed up, and the patient may accept interventional therapy in the future if necessary. LESSONS: Here, we report the rare variation of AA branches and highlight the importance of preoperative vascular assessment in surgical or interventional procedures for the affected body regions.


Assuntos
Anormalidades Múltiplas , Anormalidades Cardiovasculares/diagnóstico , Artéria Subclávia/anormalidades , Malformações Vasculares/diagnóstico , Artéria Vertebral/anormalidades , Adulto , Angiografia por Tomografia Computadorizada , Ecocardiografia , Feminino , Humanos , Artéria Vertebral/diagnóstico por imagem
8.
J Card Surg ; 36(6): 2171-2174, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33694275

RESUMO

Coarctation of the aorta discovered in adulthood is uncommon. The formation of aneurysms from the coarctation segment and in the low-pressure area is even rarer. The surgical management of coarctations can be challenging due to calcifications and concomitant cardiovascular and lung disease. We present a case with coronary artery disease, bilateral bullae, left subclavian artery aneurysm, saccular aortic aneurysms originating proximal to the coarctation and from the coarctation itself, and a remnant of ductus arteriosus. The surgical management and possible histopathologic causes for aneurysm formation are discussed.


Assuntos
Aneurisma Aórtico , Coartação Aórtica , Permeabilidade do Canal Arterial , Adulto , Aorta , Aorta Torácica , Coartação Aórtica/complicações , Coartação Aórtica/diagnóstico por imagem , Coartação Aórtica/cirurgia , Humanos , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia
9.
BMJ Case Rep ; 14(3)2021 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-33687930

RESUMO

A 35-year-old man was admitted to the intensive care unit with massive haemoptysis. CT of the chest revealed a necrotic right upper lobe mass. Angiography of his thoracic vasculature revealed a pseudoaneurysm in the right subclavian artery with active contrast extravasation. This anatomic deformity was stented and coiled with the assistance of interventional radiology. Bronchoscopy with lavage and brushings of the right upper lobe mass revealed fungal hyphae and positive galactomannan, supporting that the patient developed invasive pulmonary aspergillosis leading to a mycotic pseudoaneurysm of the right subclavian artery followed by massive haemoptysis.


Assuntos
Falso Aneurisma , Aneurisma , Adulto , Aneurisma/complicações , Aneurisma/diagnóstico por imagem , Falso Aneurisma/complicações , Falso Aneurisma/diagnóstico por imagem , Angiografia , Hemoptise/etiologia , Humanos , Masculino , Artéria Subclávia/diagnóstico por imagem
10.
BMJ Case Rep ; 14(3)2021 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-33692054

RESUMO

Haemoptysis can be a life-threatening condition, and bronchial artery embolisation (BAE) is the most effective treatment. A 19-year-old man who had been followed up for neutrophil migration failure and bronchiectasis since birth was admitted to our department with repeated haemoptysis. Contrast-enhanced CT revealed hyperplasia and tortuosity of the bronchial artery; however, it could not reveal the origin and running by the axial views. Three-dimensional (3D) and four-dimensional (4D) CT revealed branching of the right bronchial artery from the left subclavian artery and a bronchial artery-pulmonary artery shunt. Bronchial angiography confirmed these findings. Based on these findings, BAE was successfully performed. 3D and 4D CT can be useful for determining the cause of haemoptysis. Furthermore, evaluating the anatomy of bronchial arteries prior to BAE may be useful for performing safer procedures.


Assuntos
Artérias Brônquicas , Embolização Terapêutica , Adulto , Angiografia , Artérias Brônquicas/diagnóstico por imagem , Tomografia Computadorizada Quadridimensional , Hemoptise/etiologia , Hemoptise/terapia , Humanos , Masculino , Artéria Subclávia/diagnóstico por imagem , Adulto Jovem
11.
BMC Pregnancy Childbirth ; 21(1): 148, 2021 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-33602166

RESUMO

BACKGROUND: In the entire population, an aberrant right subclavian artery (ARSA) is closely associated with chromosomal abnormalities. ARSA with additional ultrasonic findings would increase risk of chromosomal abnormalities. The risk of fetal chromosomal abnormalities increased exponentially with the maternal age. These risks in the advanced maternal age (AMA) group are uncertain. This study aimed to determine the incidence of ARSA in Chinese AMA and non-AMA women and the frequency of aneuploidy among AMA and non-AMA women with ARSA. METHODS: This retrospective study included 13,690 singleton pregnancies, were divided into AMA and non-AMA groups. Integrated obstetric ultrasonic screening, biochemical screening, noninvasive prenatal screening, and fetal karyotype analysis were analyzed. RESULTS: The overall incidence of ARSA was 0.69%, with no difference between age groups. The incidence of chromosomal abnormalities in the AMA group (37 / 2860) was much higher than that of the non-AMA group. The risk of chromosomal abnormalities significantly increased with both ARSA detected and additional ultrasound findings. With combined ARSA and AMA, the likelihood of the incidence of chromosomal abnormalities increased. Chimerism (45X / 46XX) was found with isolated ARSA in AMA pregnancies. CONCLUSION: There is a high prevalence of chromosomal abnormalities in fetuses of AMA women. ARSA increases the risk of chromosomal abnormalities in both age groups, especially combined with ARSA. When ARSA occurs in AMA women, it confers a high likelihood of chromosomal abnormalities.


Assuntos
Aneuploidia , Anormalidades Cardiovasculares/diagnóstico por imagem , Aberrações Cromossômicas , Artéria Subclávia/anormalidades , Adulto , Anormalidades Cardiovasculares/epidemiologia , Feminino , Humanos , Incidência , Cariotipagem , Idade Materna , Gravidez , Segundo Trimestre da Gravidez , Estudos Retrospectivos , Fatores de Risco , Artéria Subclávia/diagnóstico por imagem , Ultrassonografia Pré-Natal , Adulto Jovem
12.
J Laparoendosc Adv Surg Tech A ; 31(5): 589-593, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33599543

RESUMO

Background: Posterolateral thoracotomy provides limited access to the thoracic apex that can result in poor visualization of subclavian vessels, their branches, and the brachial plexus. A thoracoscopic approach may overcome these limitations. Purpose: We report a thoracoscopic approach and associated technical challenges in resecting apical thoracic neuroblastoma encasing the subclavian artery. Methods: A single-institution retrospective chart review was performed (2018-2020) for patients undergoing thoracoscopic resection of apical neuroblastoma encasing the subclavian artery. Patient demographics, imaging, and hospital course were reviewed. Operative video recordings were assessed for exposure quality, technical challenges, and percentage of tumor resection. Patients were placed laterally, with three 5-mm ports triangulated to the apex. Dissection started at the tumor edge and followed along the vessel and branches. Results: Four patients (median age 2.7 years) underwent thoracoscopic apical neuroblastoma resection. Median length of stay was 2.5 days. One low-risk patient underwent resection for tumor growth during observation. One intermediate and 2 high-risk patients received neoadjuvant chemotherapy. Two patients continued having persistent vascular encasement, whereas in 1 patient the mass decreased in size and only abutted the subclavian and vertebral arteries. In 1 patient, tumor involved the brachial plexus, which was freed and preserved thoracoscopically. All cases had substantial tumor-feeding vessels branching from the subclavian artery. There was one conversion to open thoracotomy due to dense tumor adherence to the subclavian artery and vein. More than 95% resection was achieved in all cases. All patients had baseline Horner syndrome. No complications were reported. Conclusion: The thoracoscopic approach for resecting apical neuroblastoma provides optimal exposure and safe access in selected patients.


Assuntos
Neuroblastoma/cirurgia , Artéria Subclávia/cirurgia , Neoplasias Torácicas/cirurgia , Toracoscopia/métodos , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Invasividade Neoplásica , Neuroblastoma/diagnóstico por imagem , Neuroblastoma/patologia , Estudos Retrospectivos , Artéria Subclávia/diagnóstico por imagem , Neoplasias Torácicas/diagnóstico por imagem , Neoplasias Torácicas/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
13.
BMJ Case Rep ; 14(2)2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33637509

RESUMO

Arterial thoracic outlet syndrome is relatively rare and often exclusively seen in the presence of bony anomalies. High-altitude (HA) travel is commonly associated with thrombosis; however, arterial thromboembolism is less frequently described. We describe a case of a young man with undiagnosed bilateral cervical rib, who went for an HA trek, subsequent to which developed acute limb ischaemia of right arm. Diagnostic workup revealed a subclavian artery aneurysm as well along with complete bony bilateral cervical ribs. Thoracic outlet syndrome should be kept as a differential diagnosis in a case of acute limb ischaemia in a healthy adult.


Assuntos
Aneurisma , Costela Cervical , Expedições , Síndrome do Desfiladeiro Torácico , Adulto , Altitude , Aneurisma/complicações , Aneurisma/diagnóstico por imagem , Humanos , Isquemia/diagnóstico por imagem , Isquemia/etiologia , Masculino , Artéria Subclávia/diagnóstico por imagem , Síndrome do Desfiladeiro Torácico/diagnóstico por imagem , Síndrome do Desfiladeiro Torácico/etiologia
14.
Korean J Radiol ; 22(4): 577-583, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33543841

RESUMO

OBJECTIVE: To report the authors' experience in performing thoracic endovascular aortic repair (TEVAR) for zone 2 lesions after traumatic aortic injury (TAI). MATERIALS AND METHODS: This retrospective review included 10 patients who underwent zone 2 TEVAR after identification of aortic isthmus injury by CT angiography (CTA) upon arrival at the emergency room of a regional trauma center from 2016 to 2019. Patients were classified into two groups: those who underwent left subclavian artery (LSA) embolization concurrently with the main TEVAR procedure, and those in whom LSA embolization was not performed during the main procedure, but was planned as a bailout treatment if type II endoleak was noted on follow-up CTA images. Pre-procedural and procedure-related factors and post-procedure prognosis were compared between the groups. RESULTS: There were no differences in pre-procedural factors, occurrence of endoleaks, and post-procedure prognosis (including mortality) between patients in the two groups. The duration of the procedure was shorter in the non-LSA embolization group (61 minutes vs. 27 minutes, p = 0.012). During follow-up, type II endoleak did not occur in either group. CONCLUSION: Delaying preventative LSA embolization until stabilization of the patient would be desirable when performing zone 2 TEVAR for TAI, in the absence of endoleak on the completion aortography image taken after complete deployment of the stent graft.


Assuntos
Aorta Torácica/cirurgia , Doenças da Aorta/terapia , Artéria Subclávia/cirurgia , Idoso , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/lesões , Implante de Prótese Vascular/efeitos adversos , Angiografia por Tomografia Computadorizada , Embolização Terapêutica , Endoleak/diagnóstico , Endoleak/etiologia , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Stents , Artéria Subclávia/diagnóstico por imagem , Resultado do Tratamento
16.
Vasc Endovascular Surg ; 55(4): 355-360, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33535904

RESUMO

BACKGROUND: Adequate seal for thoracic endovascular aortic repair (TEVAR) commonly requires landing in zone 2, but can prove to be challenging due to the tortuous and angulated anatomy of the region. OBJECTIVES: Our objective was to determine the proximal landing accuracy of zone 2-targeted TEVARs following carotid-subclavian revascularization (CSR) and its impact on clinical outcomes. METHODS: Retrospective review of patients that underwent CSR for zone 2 endograft delivery at a tertiary institute between January 2008 and March 2018 was conducted. Technical outcomes were assessed by examining the incidence of intraoperative corrective maneuvers, 1a endoleaks and reinterventions. Distance to target and incidence of LSA stump filling were examined as radiographic markers of landing accuracy. RESULTS: Zone 2-targeted TEVAR with CSR was performed in 53 patients for treatment of dissections (49%), aneurysms (30%) or trauma (21%). Nine (17%) cases required intraoperative corrective procedures: 5 (9%) proximal cuffs due to type 1a endoleak and 4 (8%) left common carotid artery (LCCA) stenting due to inadvertent coverage. Cases performed using higher resolution hybrid fluoroscopy machine compared to mobile C-arm were associated with increased proximal cuff use (OR 8.8; 95% CI 1.2-62.4). Average distance between the proximal edge of the covered graft to LCCA was 8 ± 1 mm and larger distances were not associated with higher rates of 1a endoleak. Twenty-eight (53%) cases of antegrade LSA stump filling were noted on follow-up imaging, but were not associated with higher rates of reinterventions (OR 0.8, 95% CI [0.2-4.6]). Three (6%) patients had a stroke within 30 days and 4 (8%) patients expired within 1 month. Intraoperative corrective maneuvers, post-operative 1a endoleak and reinterventions were not associated with higher rates of stroke or mortality. CONCLUSION: Using current endografts and imaging modalities, zone 2-targeted TEVARs have suboptimal technical accuracy.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Artérias Carótidas/cirurgia , Procedimentos Endovasculares , Artéria Subclávia/cirurgia , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/mortalidade , Aneurisma Dissecante/fisiopatologia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/mortalidade , Aneurisma da Aorta Torácica/fisiopatologia , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/mortalidade , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/fisiopatologia , Endoleak/etiologia , Endoleak/mortalidade , Endoleak/terapia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Stents , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
17.
J Cardiovasc Surg (Torino) ; 62(3): 230-233, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33635042

RESUMO

BACKGROUND: Acute type B aortic dissection with origin of the left subclavian artery (LSA) is generally managed with endovascular therapy for acute coverage of the LSA with: 1) no revascularization; 2) revascularization with open methods; or 3) endovascular revascularization. To identify an alternative solution, we critically evaluated a small cohort of patients who had partial coverage of their LSA. METHODS: Three thoracic endovascular repairs were performed from January-March 2015. Patients were deemed eligible for endovascular repair after they had failed conservative management. Indications included acute type B dissection with lower extremity ischemia, ruptured dissection, and persistent symptoms of dissection after medical therapy. RESULTS: Technical success was achieved in all three patients, and all procedures were performed percutaneously. The mean distance between the ostium of the LSA and the entry point of dissection was 11.1±3.4 mm. Within the 30-day postoperative period, there were no deaths, aortic ruptures, myocardial infarctions, or conversions to open repair. Freedom from re-intervention was noted in all 3 patients. There was no spinal cord ischemia. CONCLUSIONS: There is no strong evidence to support the current optimal approach for treatment of the thoracic aorta. Partial coverage of LSA in patients with <2 cm seal zones may be considered as an alternative. However, due to our small sample size, limited follow-up, and lack of comparison cohort, further investigation is necessary.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Prótese Vascular , Procedimentos Endovasculares/métodos , Stents , Artéria Subclávia/cirurgia , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos , Resultado do Tratamento
18.
Clin Rheumatol ; 40(7): 2821-2827, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33432449

RESUMO

OBJECTIVE: To assess whether adding the subclavian artery examination into the ultrasound (US) Southend Halo Score, as proposed in the modified Halo Score, improves the diagnostic accuracy of giant cell arteritis (GCA) and its relationship with systemic inflammation. METHODS: Retrospective observational study of patients referred to a GCA fast track pathway (FTP) over a 1-year period. Patients underwent US exam of temporal and large vessel (LV) (carotid, subclavian, and axillary) arteries. The extent of inflammation was measured by the halo count, the Southend Halo Score, and the modified Halo Score. The gold standard for GCA diagnosis was clinical confirmation after 6-month follow-up. RESULTS: Sixty-four patients were evaluated in the FTP, 17 (26.5%) had GCA. Subclavian artery involvement was present only in patients with GCA (29.4% versus 0%, p < 0.001). Overall, the three scores showed excellent diagnostic accuracy for GCA (ROC AUC 0.906, 0.930, and 0.928, respectively) and moderate correlations with acute phase reactants (0.35-0.51, p < 0.01). Only the modified Halo Score correlated with markers of inflammation in patients with LV involvement. CONCLUSIONS: The inclusion of subclavian artery examination in the modified Halo Score does not improve the diagnostic accuracy of GCA. Nevertheless, it correlates better with markers of systemic inflammation in LV-GCA. Key Points • Adding the subclavian artery examination into the Southend Halo Score, as proposed in the modified Halo Score, does not improve the diagnostic accuracy of GCA. • However, the extent of vascular inflammation as quantified by the modified Halo Score correlates better with markers of systemic inflammation in the large vessel (LV) GCA subgroup of patients. • Although the diagnostic value of adding subclavian arteries to the current recommended US examination of GCA is limited, it may have a role in monitoring disease activity as it correlates with the general burden of inflammation in LV GCA. These findings need to be confirmed in additional populations and larger prospective studies.


Assuntos
Arterite de Células Gigantes , Arterite de Células Gigantes/diagnóstico por imagem , Humanos , Estudos Prospectivos , Artéria Subclávia/diagnóstico por imagem , Artérias Temporais/diagnóstico por imagem , Ultrassonografia
19.
Gen Thorac Cardiovasc Surg ; 69(5): 885-889, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33475911

RESUMO

Isolated left subclavian artery (ILSA) with right aortic arch is a rare vascular anomaly accounting for 0.8% in all right-sided aortic arch anomalies. We report a case of an isolated left subclavian artery with right aortic arch and a combination of subclavian as well as pulmonary steal in infant with Tetralogy of Fallot. We reviewed and summarized 50 similar cases reported in the literature over the last 30 years, in order to gain a thorough understanding of this rare anomaly.


Assuntos
Anormalidades Cardiovasculares , Doenças Vasculares , Malformações Vasculares , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Humanos , Lactente , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia
20.
J Card Surg ; 36(3): 1130-1133, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33442902

RESUMO

We present a case of an 11-year-old boy with a double-outlet right ventricle and a right-sided aortic arch showing anomalous origin of the left subclavian artery from the ascending aorta as the first branch. This case highlights the importance of knowledge of this aberrant anatomy before planning any surgical or endovascular intervention.


Assuntos
Aorta Torácica , Artéria Subclávia , Aorta/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Criança , Humanos , Masculino , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia
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