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Luo ZR, Zhu YP, Fang GH. Utilizing Single-Branched Stent in Combination With Fenestration or Chimney for Endovascular Repair of Aortic Arch Lesions With Aberrant Subclavian Artery. J Endovasc Ther 2024:15266028241259391. [PMID: 38887028 DOI: 10.1177/15266028241259391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
OBJECTIVE The study was to figure out the feasibility, efficacy, and safety of a single-branched stent graft, namely Castor, in combination with fenestration or chimney in the context of aortic arch lesions presenting with aberrant subclavian artery (ASA) and/or Kommerell's diverticulum (KD). METHODS All consecutive patients with aortic arch lesions and ASA and/or KD receiving Castor from June 2018 to June 2023 were investigated. RESULTS Incorporating 18 patients, the study encompassed 11 cases with KD, 3 cases with dysphagia; 2 cases of right-sided aortic arch with left-sided aberrant left subclavian artery (ALSA), and 16 cases of left-sided aortic arch with right-sided aberrant right subclavian artery (ARSA). The mean operation time was 132±23 minutes. The mean measured proximal aortic diameter was 30.9±1.6 mm, and proximal diameter of Castor stent was 34 (32, 34.5) mm, with oversize of 9.1±1.6%; the mean measured branch diameter was 8.8±0.97 mm, and branch diameter of Castor stent was 10 (8, 10) mm, with oversize of 0.86±0.57 mm. Technical success rate was 100%, and no in-hospital mortality, no stroke, and no endoleak were identified. One (5.6%) case with spinal cord ischemia and one (5.6%) case with poor healing of operative site were identified. During the follow-up period, no aortic-related death or secondary intervention was recorded. The maximal aortic diameter was significantly reduced at the sixth postoperative month (padj=0.031); KD diameter was significantly reduced at the third (padj=0.001) and sixth (padj<0.001) postoperative month. CONCLUSION Totally endovascular repair of aortic arch lesions with ASA and KD via Castor stent in combination with fenestration or chimney is feasible, effective, and safe, which can achieve an encouraging medium-term outcome and provide excellent remodeling at the lesions. CLINICAL IMPACT Single branched stent in combination with fenestration or chimney achieved a sufficient proximal landing zone and provided an encouraging medium-term outcome in this retrospective review of 18 patients receiving endovascular treatment of pathological aortic arch with aberrant subclavian artery and/or Kommerell's diverticulum. The authors suggest this time-saving and efficient technique to establish systematic experience for the treatment in this kind of patients.
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Affiliation(s)
- Zeng-Rong Luo
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, P.R. China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, China
| | - Yong-Ping Zhu
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, P.R. China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, China
| | - Guan-Hua Fang
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, P.R. China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, China
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Bhatia H, Aswal CSS, Sharma A, Singhal M. Bicarotid trunk coexisting with anomalous right vertebral and aberrant right subclavian artery. Pediatr Pulmonol 2024; 59:1476-1478. [PMID: 38358033 DOI: 10.1002/ppul.26894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 02/16/2024]
Affiliation(s)
- Harsimran Bhatia
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Arun Sharma
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manphool Singhal
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Bizhga M, Velmishi V, Sila L, Koja A, Hoxha S. Dysphagia lusoria caused by aberrant right subclavian artery associated with truncus bicaroticus in an 8-month-old girl. Case report and review of literature. LA PEDIATRIA MEDICA E CHIRURGICA 2024; 46. [PMID: 38625064 DOI: 10.4081/pmc.2024.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024] Open
Abstract
Dysphagia lusoria is a rare pediatric condition caused by extrinsic compression of the esophagus by an abnormal subclavian artery. The most common congenital abnormality in aortic arch development is an aberrant right subclavian artery. The retroesophageal right subclavian artery is typically symptomatic in 10-33% of cases. The patient, an 8-month-old girl with a history of early dysphagia and stridor, was diagnosed with an abnormal right subclavian artery. She was admitted to the pneumology service multiple times due to stridor, vomiting, and failure to thrive. During hospitalization at the gastroenterology service, a barium swallow and an upper digestive endoscopy indicated an abnormal right subclavian artery, which was confirmed by an Angiography CT scan. She underwent surgery at the age of sixteen months. All symptoms are resolved following surgical intervention, and the patient is still asymptomatic and in good clinical condition 12 months later. Every physician should be aware of abnormal right subclavian arteries and their clinical symptoms in children and adults in order to recognize and diagnose them early. Only an early evaluation may reduce complications such as delayed physical growth, dysphagia, and recurrent respiratory infections.
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Affiliation(s)
- Melpomeni Bizhga
- Service of Pediatric Pneumology, Mother Teresa Hospital, Tirana.
| | - Virtut Velmishi
- Service of Pediatric Gastroenterology, Mother Teresa Hospital, Tirana.
| | - Lorena Sila
- Pediatric Department, Mother Teresa Hospital, Tirana.
| | - Albert Koja
- Service of Pediatric Cardiology, Mother Teresa Hospital, Tirana.
| | - Stiljan Hoxha
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona.
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Spath P, Marazzi G, Stana J, Peterss S, Fernandez-Prendes C, Rantner B, Pichlmaier MA, Tsilimparis N. Endovascular Repair With Triple Inner-Branch Endograft for Aberrant Subclavian Artery Aneurysm: A Case Report. J Endovasc Ther 2024; 31:318-324. [PMID: 35941824 DOI: 10.1177/15266028221116753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Endovascular repair of the thoracic aorta (TEVAR) is the preferred option for the treatment of the distal arch and descending thoracic aorta. Fenestrated and branched TEVAR have become an option to treat pathologies of the aortic arch, avoiding sternotomy and cardiopulmonary arrest as well as total surgical debranching. We describe here the case of a symptomatic patient with an arteria lusoria aneurysm associated with Kommerel diverticulum who underwent total endovascular repair with a triple-branched TEVAR. CASE REPORT A 66-year-old male patient was treated for a symptomatic arteria lusoria artery associated with a Kommerel diverticulum, resulting in difficulty swallowing and choking. We used a custom-made triple inner-branch endograft (Cook Medical, Bloomington, Indiana) following implantation of a right-sided carotid-subclavian (C-S) bypass. The C-S bypass occluded in the interval time between the 2 procedures and required recanalization and stent-graft placement during the aortic arch procedure. The arteria lusoria was embolized with a vascular plug. No complications occurred and postoperative tomography showed exclusion and thrombosis of the Kommerel diverticulum and perfusion of the supra-aortic vessels. CONCLUSIONS Treatment of arteria lusoria aneurysms can be performed with total endovascular arch inner-branch repair, avoiding increased risk of morbidity and mortality caused by open or hybrid procedures.
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Affiliation(s)
- Paolo Spath
- Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Giulia Marazzi
- Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany
- Vascular Surgery, Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Jan Stana
- Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Sven Peterss
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | | | - Barbara Rantner
- Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany
| | | | - Nikolaos Tsilimparis
- Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany
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Sarmento Costa M, Oliveira Dias J, Vaz Silva P, Agostinho C, Souto P, Figueiredo PN. A Rare Cause of Dysphagia by Extrinsic Compression. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2024; 31:148-150. [PMID: 38572437 PMCID: PMC10987065 DOI: 10.1159/000531235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/11/2023] [Indexed: 04/05/2024]
Affiliation(s)
- Mara Sarmento Costa
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - João Oliveira Dias
- Pediatric Cardiology Department and Congenital Heart Diseases Referral Center, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Patrícia Vaz Silva
- Pediatric Cardiology Department and Congenital Heart Diseases Referral Center, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Cláudia Agostinho
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Paulo Souto
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Pedro Narra Figueiredo
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Nedelcu AH, Lupu A, Moraru MC, Tarniceriu CC, Stan CI, Partene Vicoleanu SA, Haliciu AM, Statescu G, Ursaru M, Danielescu C, Ioniuc I, Tepordei RT, Lupu VV. Morphological Aspects of the Aberrant Right Subclavian Artery-A Systematic Review of the Literature. J Pers Med 2024; 14:335. [PMID: 38672962 PMCID: PMC11051064 DOI: 10.3390/jpm14040335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/09/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The aberrant origin of the right subclavian artery (ARSA), also known as the lusoria artery, is a congenital malformation with an incidence of 0.5-4.4%. Most cases are incidental due to minimal clinical manifestations. Computer tomography (CT) is important in diagnosing and evaluating these patients. MATERIALS AND METHODS We conduct a computerized search in two databases, PubMed and EMBASE, for articles published between 1 January 2022 and 31 December 2023, PROSPERO code: CRD42024511791. Eligible for inclusion were case reports and case series that presented the aberrant origin of the right subclavian artery. The main outcome was the highlighting of the morphological types of ARSA. In this context, we proposed a new classification system of this anomaly. The secondary outcome was the evaluation of the demographic distribution of the lusoria artery. RESULTS Our search identified 47 articles describing 51 patients with ARSA. The typical course for ARSA is retroesophageal, being registered in 49 out of 51 patients. This malformation is frequently associated with Kommerell diverticulum (15 out of 51), troncus bicaroticus (7 out of 51), and aberrant origins of the right vertebral artery (7 out of 51). We observed a higher incidence of the condition among women (32 out of 51) compared to men (19 out of 51). From a demographic point of view, ARSA is more frequent in the "44 to 57 years" and "58 to 71 years" age ranges. CONCLUSIONS ARSA is a congenital malformation resulting from a defect in the development of the aortic arches. The imaging studies such as computer tomography play a defined diagnostic role.
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Affiliation(s)
- Alin Horatiu Nedelcu
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
- Radiology Clinic, Recovery Hospital, 700661 Iasi, Romania
| | - Ancuta Lupu
- Department of Mother and Child, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (I.I.); (V.V.L.)
| | - Marius Constantin Moraru
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
| | - Cristina Claudia Tarniceriu
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
| | - Cristinel Ionel Stan
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
| | - Simona Alice Partene Vicoleanu
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
| | - Ana Maria Haliciu
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
| | - Gabriel Statescu
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
| | - Manuela Ursaru
- Department of Surgical Sciences I, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (M.U.); (C.D.)
- Radiology Clinic, “Sf Spiridon” County Clinical Emergency Hospital Iasi, 700661 Iasi, Romania
| | - Ciprian Danielescu
- Department of Surgical Sciences I, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (M.U.); (C.D.)
| | - Ileana Ioniuc
- Department of Mother and Child, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (I.I.); (V.V.L.)
| | - Razvan Tudor Tepordei
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
| | - Vasile Valeriu Lupu
- Department of Mother and Child, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (I.I.); (V.V.L.)
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Valenzuela-Fuenzalida JJ, Orellana-Donoso M, Perez-Jiménez D, Farfán-Cabello E, Gold-Semmler M, Becerra-Farfan A, Román C, Nova-Baeza P. Systematic review and meta-analysis of right subclavian artery variants and their correlation with cervical-thoracic clinical conditions. Medicine (Baltimore) 2024; 103:e36856. [PMID: 38394517 DOI: 10.1097/md.0000000000036856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND A high incidence of anatomical variations in the origin of the branches of the aortic arch has been reported, Nowadays, this variation is considered the most frequent in the aortic arch, its prevalence being estimated between 0.5% and 2.5% of the population. To understand its origin, knowledge of embryonic development is necessary. METHODS We searched the MEDLINE, Scopus, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature, and Latin-American literature and caribean of health sciences databases with dates ranging from their inception to June 2023. Study selection, data extraction, and methodological quality were assessed with the guaranteed tool for anatomical studies (Anatomical Quality Assurance). Finally, the pooled prevalence was estimated using a random effects model. RESULTS Thirty-nine studies were found that met the eligibility criteria. Twenty studies with a total of 41,178 subjects were included in the analysis. The overall prevalence of an ARSA variant was 1% (95% confidence interval = 1%-2%), the clinical findings found are that if ARSA is symptomatic it could produce changes in the hemodynamic function of the thoracocervical region in addition to other associated symptomatic complications in surrounding structures. CONCLUSIONS ARSA can cause several types of alterations in the cervical or thoracic region, resulting in various clinical complications, such as lusory dysphagia. Hence, knowing this variant is extremely important for surgeons, especially those who treat the cervico-thoracic region. The low prevalence of ARSA means that many professionals are completely unaware of its existence and possible course and origin. Therefore, this study provides detailed knowledge of ARSA so that professionals can make better diagnoses and treatment of ARSA.
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Affiliation(s)
- Juan José Valenzuela-Fuenzalida
- Department of Morphology, Faculty of Medicine, Universidad Andrés Bello, Santiago, Chile
- Department of Morphology and Function, Faculty of Health, University of the Americas Santiago, Chile
| | - Mathias Orellana-Donoso
- Department of Morphology, Faculty of Medicine, Universidad Andrés Bello, Santiago, Chile
- Escuela de Medicina, Universidad Finis Terrae, Santiago, Chile
| | - Daniela Perez-Jiménez
- Department of Morphology and Function, Faculty of Health, University of the Americas Santiago, Chile
| | - Emilio Farfán-Cabello
- Departamento de Anatomía, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marjorie Gold-Semmler
- Department of Morphology, Faculty of Medicine, Universidad Andrés Bello, Santiago, Chile
| | - Alvaro Becerra-Farfan
- Departamento de Ciencias Química y Biológicas Facultad de Ciencias de la Salud, Universidad Bernardo O'Higgins
| | - Camila Román
- Department of Morphology, Faculty of Medicine, Universidad Andrés Bello, Santiago, Chile
| | - Pablo Nova-Baeza
- Department of Morphology, Faculty of Medicine, Universidad Andrés Bello, Santiago, Chile
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Palanisamy V, Shree S, Ravikumar MS, Sathiaraj AL. Unusual presentation of arteria lusoria along with ascending aortic aneurysm. Med J Armed Forces India 2023; 79:S292-S296. [PMID: 38144621 PMCID: PMC10746795 DOI: 10.1016/j.mjafi.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/31/2021] [Indexed: 10/19/2022] Open
Abstract
Arteria lusoria (AL) is a rare embryological variant that may have variable presentation ranging from asymptomatic to respiratory, abdominal, or both. Increasing incidence of radial access for coronary angiogram may lead to the incidental diagnosis of AL. Knowledge about this anatomical variation is essential for cardiologists, interventional radiologists, otorhinolaryngologists, cardiothoracic surgeons, and primary physicians. The symptomatic patient should undergo definite repair through either surgery or endovascular techniques. We present a case of incidentally diagnosed, asymptomatic AL along with ascending aortic aneurysm while evaluating for ischemic heart disease.
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Affiliation(s)
- Vijayanand Palanisamy
- Associate Consultant (Cardiac Surgery), Institute of Cardiovascular Diseases, The Madras Medical Mission, Dr. J. J. Nagar, Mogappair, Chennai, India
| | - Shilpa Shree
- Senior Registrar (Cardiac Surgery), Institute of Cardiovascular Diseases, The Madras Medical Mission, Dr. J. J. Nagar, Mogappair, Chennai, India
| | - Mithun Sundararaaja Ravikumar
- Senior Registrar (Cardiac Surgery), Institute of Cardiovascular Diseases, The Madras Medical Mission, Dr. J. J. Nagar, Mogappair, Chennai, India
| | - Antony Leander Sathiaraj
- Senior Registrar (Cardiac Surgery), Institute of Cardiovascular Diseases, The Madras Medical Mission, Dr. J. J. Nagar, Mogappair, Chennai, India
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Khedija S, Nadia A, Houcine H, Mouna B, Amine J. Incidental Finding of Arteria Lusoria in COVID-19 Patient with Aortic Thrombus Complicated by Recurrent Limb Ischemia. Int J Angiol 2023; 32:296-298. [PMID: 37927832 PMCID: PMC10624533 DOI: 10.1055/s-0043-1767762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Coronavirus disease causes a hypercoagulable state with endothelial inflammation. These conditions can produce embolic complications. Thrombosis can occur in different locations and may lead to ischemic stroke and ischemic limb. We report the case of a 64-year-old woman with recent severe acute respiratory syndrome coronavirus 2 pneumonia who was admitted to the hospital due to a giant floating thrombus in the ascending aorta with multiple ischemic events. Aortic computed tomography angiogram revealed an aberrant right subclavian artery associated with bicarotid trunk that might have protected carotid arteries from embol migration. Thrombosis is a rare clinical presentation in coronavirus disease 2019 infection but with serious complications that must be kept in mind to detect and avoid morbidities like ischemic stroke.
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Affiliation(s)
- Soumer Khedija
- Department of Cardiovascular Surgery, Abderrahmen Mami Pneumology and Phtisiology Hospital, Ariana, Tunisia
| | - Azabou Nadia
- Department of Cardiovascular Surgery, Abderrahmen Mami Pneumology and Phtisiology Hospital, Ariana, Tunisia
| | - Horchani Houcine
- Department of Cardiovascular Surgery, Abderrahmen Mami Pneumology and Phtisiology Hospital, Ariana, Tunisia
| | - Bousnina Mouna
- Department of Cardiovascular Surgery, Abderrahmen Mami Pneumology and Phtisiology Hospital, Ariana, Tunisia
| | - Jemel Amine
- Department of Cardiovascular Surgery, Abderrahmen Mami Pneumology and Phtisiology Hospital, Ariana, Tunisia
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia
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Mashru D, Murali V, Pawar P, Bharavi N, Shinde RS. Arteria Lusoria: a Menace in Robotic Esophagectomy. Indian J Surg Oncol 2023; 14:904-906. [PMID: 38187840 PMCID: PMC10768539 DOI: 10.1007/s13193-023-01800-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/04/2023] [Indexed: 01/09/2024] Open
Affiliation(s)
- Deep Mashru
- Surgical Oncology, Apollo Hospitals, Navi Mumbai, India
| | - V. Murali
- Surgical Oncology, Apollo Hospitals, Navi Mumbai, India
| | - Pravin Pawar
- Surgical Oncology, Apollo Hospitals, Navi Mumbai, India
| | - N. Bharavi
- Surgical Oncology, Apollo Hospitals, Navi Mumbai, India
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11
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Akbulut M, Celik EC, Ak A, Arslan Ö, Çekmecelioğlu D, Şişmanoğlu M, Tunçer MA. Management of complex thoracic aortic diseases with aberrant right subclavian artery. Vascular 2023:17085381231217059. [PMID: 37978808 DOI: 10.1177/17085381231217059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND We retrospectively evaluated early and intermediate outcomes of hybrid repair of complex thoracic aortic diseases involving an aberrant right subclavian artery. This paper aims to report features and available treatment options for this rare, hard-to-diagnose, and manage, aorta-related vascular condition. METHODS Between January 2012 and May 2019, 13 patients (mean age, 60.1 ± 9.3 years; nine men) underwent complex thoracic aorta repair surgery. Six patients had a thoracic aortic aneurysm, two had type A aortic dissection, and five had complicated type B aortic dissection. Hybrid repair strategies included de-branching in combination with single-stage aortic arch replacement with the frozen elephant trunk technique performed in four patients, thoracic endovascular aortic repair in six patients, and 2-stage hybrid repair consisting of a total arch replacement with a conventional/frozen elephant trunk (first stage) and subsequent endovascular repair (second stage) in three patients. RESULTS One early death occurred: a patient with acute type A aortic dissection, who underwent Bentall procedure and aortic arch replacement with the frozen elephant trunk technique, died in-hospital of multiorgan failure 41 days after the procedure. The remaining 12 patients were discharged in stable condition. The median follow-up duration was 36 months (2-71 months). Two late mortalities occurred: a patient with residual type A aortic dissection, who underwent arch replacement with the frozen elephant trunk technique, died of intracranial hemorrhage 3 months after the surgery. And 72 years old female patient died of acute exacerbation of chronic obstructive pulmonary disease 2 months after the surgery. CONCLUSION Our study indicates that various hybrid strategies can be used to treat complex thoracic aortic diseases involving an aberrant right subclavian artery. The approach of choice depends on the features of disease pathology, the aortic segments involved, and the operating surgeon's experience.
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Affiliation(s)
- Mustafa Akbulut
- Department of Cardiovascular Surgery, Koşuyolu High Specialization Education and Research Hospital, Istanbul, Turkey
| | - Ekin C Celik
- Department of Cardiovascular Surgery, Antalya Education and Research Hospital, Antalya, Turkey
| | - Adnan Ak
- Department of Cardiovascular Surgery, Koşuyolu High Specialization Education and Research Hospital, Istanbul, Turkey
| | - Özgür Arslan
- Department of Cardiovascular Surgery, Koşuyolu High Specialization Education and Research Hospital, Istanbul, Turkey
| | - Davut Çekmecelioğlu
- Department of Cardiothoracic Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mesut Şişmanoğlu
- Department of Cardiovascular Surgery, Koşuyolu High Specialization Education and Research Hospital, Istanbul, Turkey
| | - Mehmet A Tunçer
- Department of Cardiovascular Surgery, İstanbul Okan University Hospital, Istanbul, Turkey
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Inomata Y, Hanaoka Y, Koyama JI, Yamazaki D, Kitamura S, Nakamura T, Horiuchi T. Left Transradial Access Using a Radial-Specific Neurointerventional Guiding Sheath for Coil Embolization of Anterior Circulation Aneurysm Associated With the Aberrant Right Subclavian Artery: Technical Note and Literature Review. World Neurosurg 2023; 178:126-131. [PMID: 37506842 DOI: 10.1016/j.wneu.2023.07.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Aberrant right subclavian artery (ARSA) is a rare condition, but the most common anomaly of the aortic arch. Although neurointerventions via transradial access (TRA) are becoming increasingly popular worldwide, transradial carotid cannulation has been extremely challenging in patients with an ARSA. Herein, we present a case of ARSA-associated anterior communicating artery (ACoA) aneurysm that was successfully treated with a radial-specific 6F Simmons guiding sheath via left TRA. We also review the relevant literature. METHODS A 68-year-old-woman who was diagnosed as having an ARSA-associated ACoA aneurysm underwent simple coiling via left TRA. After the 6F Simmons guiding sheath was engaged into the right common carotid artery using the pull-back-technique, transradial quadraxial system (6F Simmons guiding sheath/6F intermediate catheter/3.2F intermediate catheter/coil-delivery microcatheter) was implemented. RESULTS Simple coiling of the aneurysm was successfully achieved without catheter kinking or system instability. The postprocedural course was uneventful. A follow-up magnetic resonance angiography showed no evidence of recanalization 1 years 9 months after the procedure. CONCLUSIONS Transradial anterior circulation intervention has been rarely used for patients with an ARSA due to unfavorable catheter trajectory. Left TRA using the 6F Simmons guiding sheath is a useful treatment option to address anterior circulation interventions for patients with an ARSA. Preoperative diagnosis of ARSA is necessary for the application of our method.
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Affiliation(s)
- Yuki Inomata
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan.
| | - Jun-Ichi Koyama
- Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
| | - Daisuke Yamazaki
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Satoshi Kitamura
- Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
| | - Takuya Nakamura
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
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13
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Hirayu N, Fukuda M, Nabeta M, Takasu O. Aberrant Right Subclavian Artery Complicated by Acquired Hemophilia A and a Subclavian Artery-Esophageal Fistula after Traumatic Injury. J Emerg Trauma Shock 2023; 16:182-184. [PMID: 38292277 PMCID: PMC10824208 DOI: 10.4103/jets.jets_22_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/07/2023] [Accepted: 04/08/2023] [Indexed: 02/01/2024] Open
Abstract
An aberrant right subclavian artery (ARSA) is a rare developmental anomaly wherein the right subclavian artery arises from the descending aorta as a fourth branch of the aortic arch. We present the case of ARSA in an 81-year-old woman who was injured in a motorcycle accident. The patient had a history of asymptomatic cerebral infarction, type 2 diabetes mellitus, and rheumatoid arthritis. She was diagnosed with spleen and liver injury, left renal injury, along with fractures in the rib, pelvic, vertebrae, and right tibia. On the 3rd hospitalization day, activated partial thromboplastin time (APTT) prolongation was observed, followed by sudden massive hematemesis and shock on the 39th day. We indicate sudden hematemesis and ARSA bleeding as the cause. We performed compression with a Sengstaken-Blakemore tube and coil embolization for hemostasis. Our findings show that the bleeding was mainly caused by nasogastric tube compression, prolonged APTT, and acquired hemophilia A.
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Affiliation(s)
- Nobuhisa Hirayu
- Advanced Emergency and Critical Care Center, Kurume University Hospital, Kurume, Fukuoka, Japan
- Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Masafumi Fukuda
- Advanced Emergency and Critical Care Center, Kurume University Hospital, Kurume, Fukuoka, Japan
| | - Masakazu Nabeta
- Advanced Emergency and Critical Care Center, Kurume University Hospital, Kurume, Fukuoka, Japan
- Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Osamu Takasu
- Advanced Emergency and Critical Care Center, Kurume University Hospital, Kurume, Fukuoka, Japan
- Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
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14
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Jones EL, Riangwiwat T, Blankenship JC. A Simple Method to Diagnose Arteria Lusoria During Right Radial Access Coronary Intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 53S:S227-S229. [PMID: 35868996 DOI: 10.1016/j.carrev.2022.06.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/06/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022]
Abstract
Arteria lusoria (aberrant right subclavian artery) occurs in approximately 0.1-2.4 % of all individuals. The resulting tortuosity can pose a challenge for coronary angiography using radial artery access, but also can aid in the diagnosis if not already established. This case series reports three patients diagnosed with arteria lusoria by a single low-volume catheterization operator over a 6-month period, noting that its prevalence may be higher than usually reported, can be suspected when a catheter from the right radial artery crosses the midline and forms a loop as it traverses to the ascending aorta, and that it does not preclude successful catheterization and coronary intervention.
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Affiliation(s)
- Erika L Jones
- Division of Cardiology, University of New Mexico, Albuquerque, NM, United States of America
| | - Tanawan Riangwiwat
- Department of Cardiology, Geisinger Medical Center, Danville, PA, United States of America
| | - James C Blankenship
- Division of Cardiology, University of New Mexico, Albuquerque, NM, United States of America.
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15
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Hackett AM, Luther E, Huang E, Walker AP, Brim WR, Maddy K, Burks JD, Lu VM, Silva MA, Peterson EC. In Reply: Transradial Flow-Diverting Stent Placement Through an Arteria Lusoria: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 25:e118. [PMID: 37195057 DOI: 10.1227/ons.0000000000000772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 05/18/2023] Open
Affiliation(s)
- Ashia M Hackett
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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16
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Tesfaye W, Mekonen A, Feyisa M, Kassa S. Transhiatal esophagectomy on a patient with aberrant right subclavian artery: A case report. Int J Surg Case Rep 2023; 108:108438. [PMID: 37406530 PMCID: PMC10382764 DOI: 10.1016/j.ijscr.2023.108438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/12/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION Esophageal dissection is generally safe and easy during transhiatal esophagectomy (THE). The right subclavian artery crosses between the esophagus and spine in about 1 % to 2 % of cases. This condition is called aberrant right subclavian artery and is the most common congenital aortic arch anomaly. Pre-operative recognition of this anomaly is important in esophageal surgeries. In unprepared situations injury to this vessel may result in life threatening bleeding. CASE PRESENTATION A 45 year old female patient presented with progressive dysphagia and weight loss. Esophageal mass was found during upper gastrointestinal endoscopy. Additionally, a CT scan of the thorax and abdomen revealed an aberrant right subclavian artery and a distal esophageal mass. Biopsy revealed squamous cell carcinoma. A transhiatal esophagectomy was performed successfully with no complications. DISCUSSION The vast majority of patients with an aberrant right subclavian artery do not experience any symptoms. In rare cases, patients may present with dysphagia (dysphagia lusoria) and obstructive respiratory symptoms in their fourth or fifth decade. When patients present with dysphagia from esophageal cancer, careful review of imaging is needed to identify the aberrant artery. CONCLUSION The presence of aberrant right subclavian artery causes difficulty in performing esophagectomy. If it is diagnosed preoperatively, cautious retroesophageal dissection prevents injury to this vessel and complications following it.
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Affiliation(s)
- Workneh Tesfaye
- Cardiothoracic Unit, Department of Surgery, College of Health Sciences, Addis Ababa University, Ethiopia.
| | - Abenezer Mekonen
- Cardiothoracic Unit, Department of Surgery, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Mekonnen Feyisa
- Cardiothoracic Unit, Department of Surgery, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Seyoum Kassa
- Cardiothoracic Unit, Department of Surgery, College of Health Sciences, Addis Ababa University, Ethiopia
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17
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Hackett A, Luther E, Huang E, Walker A, Brim WR, Maddy K, Burks J, Lu VM, Silva MA, Peterson E. Transradial Flow-Diverting Stent Placement Through an Arteria Lusoria: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 24:e438. [PMID: 36723287 DOI: 10.1227/ons.0000000000000635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/28/2022] [Indexed: 02/02/2023] Open
Affiliation(s)
- Ashia Hackett
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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18
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Chandrupatla M, Raviteja P, Motwani R. Arteria lusoria with patent foramen ovale: clinical and embryological significance with literature review. Surg Radiol Anat 2023:10.1007/s00276-023-03170-3. [PMID: 37208449 DOI: 10.1007/s00276-023-03170-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/15/2023] [Indexed: 05/21/2023]
Abstract
A 73-year-old female donated cadaver had an unusual origin of the right subclavian artery (RSA), which is usually known as 'Arteria lusoria' (AL) or "Aberrant Right Subclavian Artery" (ARSA). This artery originated as the fourth and most extreme left branch from the arch of the aorta (AOA), distal to the origin of the left subclavian artery (LSA), and traversed obliquely upwards, towards the right side posterior to the oesophagus, heading for the thoracic inlet. The brachiocephalic trunk (BCT) was absent. The right common carotid (RCCA), left common carotid (LCCA), LSA and ARSA were four branches that originated from the aortic arch and ran from right to left. The course and distribution of these branches were normal. On opening the right atrium, a patent foramen ovale (PFO) was observed in the upper part of the interatrial septum. As far as we know, this is the first cadaveric case report of arteria lusoria with the presence of an atrial septal defect in the form of a PFO. Early diagnosis of aortic arch abnormalities using diagnostic interventions is beneficial for identifying risk factors after invasive procedures.
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Affiliation(s)
| | - Punnapa Raviteja
- Department of Anatomy, AIIMS Bibinagar, Hyderabad, 508126, India
| | - Rohini Motwani
- Department of Anatomy, AIIMS Bibinagar, Hyderabad, 508126, India.
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19
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Tallarita T, Rogers RT, Bower TC, Stone W, Farres H, Money SR, Colglazier JJ. Characterization and surgical management of aberrant subclavian arteries. J Vasc Surg 2023; 77:1006-1015. [PMID: 36565775 DOI: 10.1016/j.jvs.2022.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Aberrant subclavian arteries (aSCAs), with or without aortic pathology, are uncommon. The purpose of the present study was to review our experience with the surgical management of aSCA. METHODS We performed a retrospective review of patients who had undergone surgery for an aSCA between 1996 and 2020. Symptomatic and asymptomatic patients were included. The primary end points were ≤30-day and late mortality. The secondary end points were ≤30-day complications, graft patency, and reinterventions. RESULTS A total of 46 symptomatic and 3 asymptomatic patients with aSCA had undergone surgery (31 females [62%]; median age, 45 years). An aberrant right subclavian artery was present in 38 (78%) and an aberrant left subclavian artery in 11 patients (22%). Of the 49 patients, 41 (84%) had had a Kommerell diverticulum (KD) and 11 (22%) had had a concomitant distal arch or proximal descending thoracic aortic aneurysm. Symptoms included dysphagia (56%), dyspnea (27%), odynophagia (20%), and upper extremity exertional fatigue (16%). Five patients (10%) had required emergency surgery. The aSCA had been treated by transposition in 32, a carotid to subclavian bypass in 11, and an ascending aorta to subclavian bypass in 6. The KD was treated by resection and oversewing in 19 patients (39%). Fifteen patients (31%) had required distal arch or proximal descending thoracic aortic replacement for concomitant aortic disease and/or KD treatment. Thoracic endovascular aortic repair was used to exclude the KD in six patients (12%). Seven patients (14%) had undergone only bypass or transposition. The 30-day complications included one death from pulseless electrical activity arrest secondary to massive pulmonary embolism. The 30-day major complications (14%) included acute respiratory failure in three, early mortality in one, stroke in one, non-ST-elevation myocardial infarction in one, and temporary dialysis in one patient. The other complications included chylothorax/lymphocele (n = 5; 10%), acute kidney injury (n = 2; 4%), pneumonia (n = 2; 4%), wound infection (n = 2; 4%), atrial fibrillation (n = 2; 4%), Horner syndrome (n = 2; 4%), lower extremity acute limb ischemia (n = 1; 2%), and left recurrent laryngeal nerve injury (n = 1; 2%). At a median follow-up of 53 months (range, 1-230 months), 40 patients (82%) had had complete symptom relief and 9 (18%) had experienced improvement. Six patients had died at a median of 157 months; the deaths were not procedure or aortic related. The primary patency was 98%. Reintervention at ≤30 days had been required for two patients (4%) for ligation of lymphatic vessels and bilateral lower extremity fasciotomy after proximal descending thoracic aorta replacement. One patient had required late explantation of an infected and occluded carotid to subclavian bypass graft, which was treated by cryopreserved allograft replacement. CONCLUSIONS Surgical treatment of the aSCA can be accomplished with low major morbidity and mortality with excellent primary patency and symptom relief.
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Affiliation(s)
- Tiziano Tallarita
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Richard T Rogers
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN.
| | - Thomas C Bower
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - William Stone
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Phoenix, AZ
| | - Houssam Farres
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL
| | - Samuel R Money
- Division of Vascular Surgery, Ochsner Health Center, New Orleans, LA
| | - Jill J Colglazier
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
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20
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Nasser M, Petrocheli BB, Felippe TKS, Isola B, dos Santos Pereira BC, Sartoreli ALC, Batista JM, Brandão GMS. Aberrant right subclavian artery: case report and literature review. J Vasc Bras 2023; 22:e20210151. [PMID: 36855544 PMCID: PMC9968513 DOI: 10.1590/1677-5449.202101512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/17/2022] [Indexed: 02/22/2023] Open
Abstract
The aberrant right subclavian artery, also known as the arteria lusoria, is the most common aortic arch anomaly, occurring in 0.5 to 1% of the population. There is a higher prevalence in women and it is usually associated with other anatomical variations, such as the non-recurrent laryngeal nerve, present in 86.7% of cases. In the majority of cases, the aberrant right subclavian artery causes no symptoms. We describe this anomaly in an 82-year-old, hypertensive, and asymptomatic patient who had undergone a thoracoabdominal angiography to investigate a chronic DeBakey type III aortic dissection with dilation of the descending aorta. The aberrant right subclavian artery followed a retroesophageal course and was associated with a Kommerell diverticulum. In view of its rarity, we conducted an integrative bibliographic review of literature from the last 6 years indexed on the Medline, UpToDate, Lilacs, Scielo, and Portal Capes databases and discuss the most frequent anatomical changes, symptomatology, and therapeutic management adopted.
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Affiliation(s)
- Michel Nasser
- Universidade Federal de São Carlos - UFSCar, Departamento de Medicina, São Carlos, SP, Brasil.
| | | | | | - Beatriz Isola
- Universidade Federal de São Carlos - UFSCar, Departamento de Medicina, São Carlos, SP, Brasil.
| | | | | | - João Marques Batista
- Universidade Federal de São Carlos - UFSCar, Departamento de Medicina, São Carlos, SP, Brasil.
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21
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Kuroiwa M, Hanaoka Y, Koyama JI, Yamazaki D, Kubota Y, Kitamura S, Ichinose S, Nakamura T, Kamijo T, Fujii Y, Ogiwara T, Murata T, Horiuchi T. Transradial Mechanical Thrombectomy Using a Radial-specific Neurointerventional Guiding Sheath for Anterior Circulation Large-Vessel Occlusions: Preliminary Experience and Literature Review. World Neurosurg 2023; 171:e581-e589. [PMID: 36529427 DOI: 10.1016/j.wneu.2022.12.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Transradial mechanical thrombectomy (MT) is increasingly used because it is associated with a low incidence of vascular access site complications. However, transradial carotid cannulation can be technically challenging to perform in patients with an unfavorable supra-aortic takeoff. In this study, the feasibility and safety of a new transradial MT system with a radial-specific neurointerventional guiding sheath-6F Simmons guiding sheath was evaluated-in patients with anterior circulation large-vessel occlusions. Additionally, a literature review was performed. METHODS We retrospectively analyzed data from our institutional database about consecutive patients who underwent transradial MT for anterior circulation large-vessel occlusion. After the 6F Simmons guiding sheath was engaged into the target common carotid artery, a triaxial system (Simmons guiding sheath/aspiration catheter/microcatheter), was established. MT using the continuous aspiration prior to intracranial vascular embolectomy technique was performed. Then, procedural success rate, successful revascularization, and procedure-related complications were assessed. RESULTS A total of 13 patients who had transradial MT were included in the analysis. All 13 patients underwent successful thrombectomy without catheter kinking or system instability, and 12 of them achieved successful revascularization (modified Thrombolysis in Cerebral Infarction score of ≥2b). No complications occurred. CONCLUSIONS To the best of our knowledge, this is the first case series on transradial MT using a radial-specific neurointerventional system for anterior circulation large-vessel occlusions. This method may increase the success rate of transradial MT. Based on our initial experience, transradial MT, using this system, was feasible and safe for anterior circulation large-vessel occlusions.
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Affiliation(s)
- Masafumi Kuroiwa
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Department of Neurosurgery, Shinonoi General Hospital, Nagano, Japan
| | - Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan.
| | - Jun-Ichi Koyama
- Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
| | - Daisuke Yamazaki
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuki Kubota
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Satoshi Kitamura
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shunsuke Ichinose
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takuya Nakamura
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Department of Neurosurgery, Shinonoi General Hospital, Nagano, Japan
| | - Takaaki Kamijo
- Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
| | - Yu Fujii
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Toshihiro Ogiwara
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takahiro Murata
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Department of Neurosurgery, Shinonoi General Hospital, Nagano, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
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22
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Freycon-Tardy L, Ozdemir BA, Hireche K, Alric P, Canaud L. Double Fenestrated Physician-Modified Stent Graft for Endovascular Treatment of Traumatic Aortic Isthmus Rupture With an Aberrant Right Subclavian Artery. J Endovasc Ther 2023; 30:151-155. [PMID: 35094606 DOI: 10.1177/15266028211070964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of the study was to demonstrate the feasibility of urgent endovascular treatment of a traumatic aortic isthmus rupture in a patient with an aberrant right subclavian artery. CASE REPORT A 23-year-old man was admitted to a regional trauma center after a motor vehicle collision and found to have cerebral trauma and a large pseudoaneurysm of the aortic arch. Trauma computed tomography (CT) identified a blunt traumatic thoracic aortic injury with an aortic false aneurysm in the context of an aberrant right subclavian artery. A hybrid repair was performed with bilateral subclavian carotid bypasses and a double fenestrated physician-modified stent graft. The patient had an uneventful postoperative course. Postoperative CT scan showed sealing of the aortic arch rupture and patency of all the supra-aortic trunks. CONCLUSION Endovascular repair of blunt traumatic thoracic aortic injury is considered first-line therapy. Aortic arch anomalies add complexity to treatment. This report demonstrates that a hybrid strategy with bilateral carotid-axillary bypasses and homemade double fenestrated endograft of the aortic arch is a valuable approach for this challenging emergency in the context of an aberrant right subclavian artery.
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Affiliation(s)
- Leonore Freycon-Tardy
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Baris Ata Ozdemir
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.,University of Bristol, Bristol, UK
| | - Kheira Hireche
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Pierre Alric
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.,PhyMedExp, CNRS, INSERM, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Ludovic Canaud
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.,PhyMedExp, CNRS, INSERM, CHU Montpellier, University of Montpellier, Montpellier, France
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23
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A systematic review of open, hybrid, and endovascular repair of aberrant subclavian artery and Kommerell's diverticulum treatment. J Vasc Surg 2023; 77:642-649.e4. [PMID: 35850164 DOI: 10.1016/j.jvs.2022.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/16/2022] [Accepted: 07/07/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Aberrant subclavian artery (AScA) with or without associated Kommerell's diverticulum (KD) is the most frequently encountered anomaly of the aortic arch, it may be life threatening, especially when associated with aneurysmal degeneration. The best management is still debated and depends on many clinical and anatomical factors. A systematic review was conducted to assess the current evidence on the treatment options and their efficacy and safety for AscA and KD repairs. METHODS A literature search in PubMed and Cochrane Library was performed, and articles that were published from January 1947 to August 2021 reporting on AscA and KD management were identified. Multicenter studies, single-center series, and case series with three or more patients were considered eligible in the present review. A comparison of outcomes of patients who underwent open surgery (OS), a hybrid approach (HA), and total endovascular repair (ER) (ie, 30-day mortality and stroke were analyzed when available and compared among the three groups (P < .05; Benjamini and Hochberg-adjusted P < .05; Bonferroni-adjusted P < .05). Titles, abstracts, and full texts were evaluated by two authors independently. Primary outcomes included survival rate, perioperative stroke, arm ischemia, and spinal cord ischemia. Endoleak, in the case of HA and ER, and reintervention rates were considered outcomes. RESULTS Three hundred thirty-one articles were initially evaluated and 30 studies, totaling 426 patients treated for AScA with 324 KD, were included. Of the 426 patients, 241 were male (56.5%), and the mean patient age was 57.9 ± 12.0 years. The approach was OS in 228 patients, HA in 147 patients, and ER in 51. Dysphagia was the most common presentation in 133 cases. Aortic rupture was observed in 16 of the 426 patients (3.8%), including 14 AScA/KD (3.3%) aneurysm rupture. KD maximum diameter varied widely from 12.6 to 63.6 mm. The overall 30-day mortality was 20 (4.7%) (OS group 8/228 [3.5%]; HA group 10/147 [6.8%]; ER 2/51 [3.9%]; P = NS). The overall stroke rate was 4.9% (21/426) (OS group 10/228 [4.4%]; HA group 6/147 [4.1%]; ER group 5/51 [9.8%]; P = NS), including nine transient and nondisabling neurological deficits. Overall secondary procedures for complications were reported in 36 of the 426 cases (8.4%), mostly owing to endoleak. Follow-up varied from 13 to 74 months. CONCLUSIONS This systematic review assessed the current outcomes of the three types of therapeutic management for AScA and KD and demonstrated that they are all relatively safe and effective, providing satisfactory early and midterm outcomes. Long-term outcomes are warranted, especially for total ERs since the long-term durability of stent grafts remains unknown.
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24
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Clinical Characteristics and Computed Tomography Findings in Adult Patients With an Aberrant Right Subclavian Artery: A Single-Center Retrospective Cohort Study. J Comput Assist Tomogr 2023; 47:382-389. [PMID: 36728158 DOI: 10.1097/rct.0000000000001435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We sought to determine the prevalence and possible features associated with symptoms in adult patients diagnosed with an aberrant right subclavian artery (ARSA). METHODS In this single-center retrospective study, 386 adult patients were diagnosed with ARSA on chest CT scans performed between June 2016 and April 2021. Patients were grouped by the presence of symptoms, which included dysphagia, shortness of breath, cough, and upper airway wheezing. Four cardiothoracic radiologists reviewed the chest CT scans to assess features of ARSA. Agreement and multivariable logistic regression analyses were performed to determine interobserver variability and features associated with the presence of symptoms, respectively. RESULTS The prevalence of ARSA was 1.02% and 81.3% of patients were asymptomatic. Shortness of breath (74.6%) was the most common symptom. Interobserver agreement was acceptable with most variables having an interclass correlation coefficient or κ >0.80. A patient's height > 158 cm (OR: 2.50, P = 0.03), cross-sectional area > 60 mm2 of ARSA at the level of the esophagus (OR: 2.39, P = 0.046), and angle >108 degrees formed with the aortic arch (OR: 1.99, P = 0.03) were associated with the presence of symptoms on multivariable logistic regression. A distance increase per 1 mm between ARSA and trachea (OR: 0.85, P = 0.02) was associated with decreased odds of symptoms. CONCLUSIONS Aberrant right subclavian artery is an incidental finding in most adult patients. The cross-sectional area at the level of the esophagus, angle formed with the medial wall of the aortic arch, distance between the ARSA and the trachea, and a patient's height were features associated with the presence of symptoms.
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Nasser M, Petrocheli BB, Felippe TKS, Isola B, Pereira BCDS, Sartoreli ALC, Batista Junior JM, Brandão GMS. Artéria subclávia direita aberrante: relato de caso e revisão de literatura. J Vasc Bras 2023. [DOI: 10.1590/1677-5449.202101511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Resumo A artéria subclávia direita aberrante, também conhecida como artéria lusória, é a anomalia do arco aórtico mais comum, ocorrendo entre 0,5 e 1% da população. Possui prevalência em mulheres e normalmente está associada a outras variações anatômicas, como o nervo laríngeo não recorrente, presente em 86,7% dos casos. Em sua maioria, a artéria subclávia direita aberrante não apresenta sintomas. Descrevemos essa alteração em uma paciente de 82 anos, hipertensa e assintomática, que havia sido submetida a uma angiotomografia toracoabdominal para a avaliação de uma dissecção crônica tipo III (DeBakey) associada à dilatação de aorta descendente. No achado, a artéria subclávia direita aberrante apresentava percurso retroesofágico associado a um divertículo de Kommerell. Devido à raridade, realizamos revisão bibliográfica integrativa das bases de dados MEDLINE, UpToDate, LILACS, SciELO e Portal CAPES dos últimos 6 anos e discutimos as alterações anatômicas mais frequentes, a sintomatologia e as condutas terapêuticas adotadas.
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26
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Root of the Neck and Extracranial Vessel Anatomy. Neuroimaging Clin N Am 2022; 32:851-873. [DOI: 10.1016/j.nic.2022.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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27
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Ruiz EF, Ahsan M, Laharwal MM. The hardest pill to swallow: A freak of nature. Eur J Intern Med 2022; 103:104-106. [PMID: 35780072 DOI: 10.1016/j.ejim.2022.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/27/2022] [Indexed: 11/03/2022]
Abstract
Not required.
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Affiliation(s)
- Eloy F Ruiz
- Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ, United States.
| | - Muhammad Ahsan
- Department of Internal Medicine, Cooperman Barnabas Medical Center, RWJBarnabas Health, Livingston, NJ, United States
| | - Mehak M Laharwal
- Department of Internal Medicine, Cooperman Barnabas Medical Center, RWJBarnabas Health, Livingston, NJ, United States
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Mansour MM, Darweesh M, Mahfouz R, Obeidat AE, Das K. Aberrant Right Subclavian Artery Causing Dysphagia: A Case Report of Dysphagia Lusoria. Cureus 2022; 14:e25980. [PMID: 35859972 PMCID: PMC9287622 DOI: 10.7759/cureus.25980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 11/09/2022] Open
Abstract
Dysphagia lusoria is a rare condition, with a prevalence of less than 1%, that occurs through secondary compression of the esophagus posteriorly by an aberrant right subclavian artery. It commonly presents with dysphagia to solids. Management is usually done with dietary modification; however, more severe and intractable cases may require surgical intervention. We describe this rare vascular anomaly in a 54-year-old female presenting with mechanical dysphagia.
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29
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Marchenko AV, Myalyuk PA, Kadyraliev BK, Musaev OG, Lilothia SH, Vronsky AS, Khramtsov VS, Enginoev ST, Arutyunyan VB, Sinelnikov YS. Surgical treatment of Kommerell's diverticulum. J Card Surg 2022; 37:2873-2878. [PMID: 35665965 DOI: 10.1111/jocs.16646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/30/2022]
Abstract
Kommerell's diverticulum (KD) is a rare congenital vascular abnormality due to the formation of an abnormal aortic arch, most commonly associated with dilatation at the proximal part of the aberrant subclavian artery. This article describes an option of surgical treatment in a patient with KD. The proposed new technique of aortic arch surgical reconstruction with a stent-graft placement in the descending aorta reduces CPB time, aortic clamp and circulatory arrest time.
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Affiliation(s)
- Andrey V Marchenko
- Federal State Budgetary Institution "Federal Center of Cardiovascular Surgery named after S.G. Sukhanov" of the Ministry of Health of the Russian Federation, Perm, Perm Region, Russian Federation
| | - Pavel A Myalyuk
- Federal State Budgetary Institution "Federal Center of Cardiovascular Surgery named after S.G. Sukhanov" of the Ministry of Health of the Russian Federation, Perm, Perm Region, Russian Federation
| | - Bakytbek K Kadyraliev
- Federal State Budgetary Institution "Federal Center of Cardiovascular Surgery named after S.G. Sukhanov" of the Ministry of Health of the Russian Federation, Perm, Perm Region, Russian Federation
| | - Orkhan G Musaev
- Federal State Budgetary Institution "Federal Center of Cardiovascular Surgery named after S.G. Sukhanov" of the Ministry of Health of the Russian Federation, Perm, Perm Region, Russian Federation
| | - Sophia H Lilothia
- Federal State Budgetary Institution "Federal Center of Cardiovascular Surgery named after S.G. Sukhanov" of the Ministry of Health of the Russian Federation, Perm, Perm Region, Russian Federation
| | - Alexey S Vronsky
- Federal State Budgetary Institution "Federal Center of Cardiovascular Surgery named after S.G. Sukhanov" of the Ministry of Health of the Russian Federation, Perm, Perm Region, Russian Federation
| | - Vitaliy S Khramtsov
- Federal State Budgetary Institution "Federal Center of Cardiovascular Surgery named after S.G. Sukhanov" of the Ministry of Health of the Russian Federation, Perm, Perm Region, Russian Federation
| | - Soslan T Enginoev
- Federal State Budgetary Institution "Federal Center of Cardiovascular Surgery" of the Ministry of Health of the Russian Federation, Astrakhan, Astrakhan Region, Russian Federation.,Federal State Budgetary Educational Institution of Higher Education "Astrakhan State Medical University" of the Ministry of Health of the Russian Federation, Astrakhan, Astrakhan Region, Russian Federation
| | - Vagram B Arutyunyan
- Federal State Budgetary Institution "Federal Center of Cardiovascular Surgery named after S.G. Sukhanov" of the Ministry of Health of the Russian Federation, Perm, Perm Region, Russian Federation
| | - Yuriy S Sinelnikov
- Federal State Budgetary Institution "Federal Center of Cardiovascular Surgery named after S.G. Sukhanov" of the Ministry of Health of the Russian Federation, Perm, Perm Region, Russian Federation
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30
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Salem R, Anantharajah L, Hecker F, Nour-Eldin NEA, Hlavicka J, Walther T, Holubec T. Minimally Invasive Treatment of Kommerell's Diverticulum and Left Aberrant Subclavian Artery. Ann Thorac Surg 2022; 114:e313-e315. [PMID: 35216988 DOI: 10.1016/j.athoracsur.2022.01.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/17/2022] [Accepted: 01/23/2022] [Indexed: 11/19/2022]
Abstract
Kommerell's diverticulum is an aneurysmatic off-spring of the left aberrant subclavian artery, which is a rare vascular anomaly of the aortic arch. Here, we present our less invasive approach to the repair of a symptomatic Kommerell's diverticulum in a 31-year-old patient, without the use of cardio-pulmonary bypass.
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Affiliation(s)
- Razan Salem
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, Frankfurt, Germany
| | - Luxia Anantharajah
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, Frankfurt, Germany
| | - Florian Hecker
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, Frankfurt, Germany
| | - Nour Eldin A Nour-Eldin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt and Goethe University Frankfurt, Frankfurt, Germany; Department of Diagnostic and Interventional Radiology, Cairo University Hospital, Cairo, Egypt
| | - Jan Hlavicka
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, Frankfurt, Germany
| | - Thomas Walther
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, Frankfurt, Germany
| | - Tomas Holubec
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, Frankfurt, Germany.
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31
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Stavridis K, Antsaklis P, Theodora M, Tasias K, Daskalakis G. Prenatal diagnosis of aberrant right subclavian artery: a literature review. J Matern Fetal Neonatal Med 2022; 35:8856-8862. [PMID: 35156496 DOI: 10.1080/14767058.2021.2005570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The primary aim of this review is to estimate the prevalence of ARSA both in euploid fetuses as well as in fetuses with Down Syndrome. Secondary objectives were to estimate the association of ARSA with cardiac anomalies and chromosomal defects, especially trisomy 21 and 22q11 deletion (DiGeorge Syndrome). The incidence of ARSA in normal population varies from 0.35% to 3.5%, based on different studies. Since the first reported association between ARSA and trisomy 21 in 2015 until today, several studies have emerged to confirm different degrees of this correlation. Indeed, ARSA appears to be a clinically useful prenatal ultrasound marker for trisomy 21. Particularly, most recent studies concluded that ARSA as a non-isolated finding can be used as screening for Down syndrome. However, when ARSA is an isolated finding, various studies proved that there is no significant correlation with Down syndrome. Apart from these, ARSA appears to be associated with other chromosomal abnormalities, such as 22q11 deletion, cardiac defects and other morphological anomalies. As a conclusion ARSA should be characterized as isolated or non-isolated, as the non - isolated ARSA appears to be a clinically useful marker of Down syndrome and thus, additional testing is required when diagnosed.
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Affiliation(s)
| | - Panos Antsaklis
- First Department of Obstetrics and Gynecology, University of Athens, Athens, Greece
| | - Marianna Theodora
- First Department of Obstetrics and Gynecology, University of Athens, Athens, Greece
| | - Konstantinos Tasias
- First Department of Obstetrics and Gynecology, University of Athens, Athens, Greece
| | - Georgios Daskalakis
- First Department of Obstetrics and Gynecology, University of Athens, Athens, Greece
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32
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Marsafi O, Chahbi Z, Wakrim S. When Arteria lusoria meets Truncus bicaroticus: one of the rarest combinations of aortic arch anomalies. Radiol Case Rep 2022; 17:412-415. [PMID: 34934466 PMCID: PMC8654611 DOI: 10.1016/j.radcr.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 10/30/2021] [Accepted: 11/02/2021] [Indexed: 11/28/2022] Open
Abstract
The Arteria lusoria or aberrant right subclavian artery (ARSA) constitutes one of the rarest malformations of the aortic arch, it can be associated with other congenital anomalies of the heart and large vessels, in particular the bi-carotid trunk or common origin of the carotid arteries (COCA) which is the presence of a single branch from the aorta giving off both right and left common carotid arteries. We report the case of a patient followed for severe mitral stenosis, and hospitalized for an ischemic cerebral vascular accident, a chest CT scan was performed in front of her clinical and biological degradation, which allowed the fortuitous discovery of an Arteria lusoria (aberrant retro-esophagealartery) associated with a Truncus bicaroticus.
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Affiliation(s)
- Oussama Marsafi
- Department of Radiology, Faculty of Medicine and Pharmacy, University Hospital of Souss Massa, Ibn Zohr Agadir University, Agadir, Morocco
| | - Zakaria Chahbi
- Department of Radiology, Faculty of Medicine and Pharmacy, University Hospital of Souss Massa, Ibn Zohr Agadir University, Agadir, Morocco
| | - Soukaina Wakrim
- Department of Radiology, Faculty of Medicine and Pharmacy, University Hospital of Souss Massa, Ibn Zohr Agadir University, Agadir, Morocco
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33
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Murukendiran GJ, Dash P, Azeez A, Palanisamy N, Pitchai S. Symptomatic aberrant right subclavian artery—A case report and anesthetic implications. Ann Card Anaesth 2022; 25:81-84. [PMID: 35075026 PMCID: PMC8865346 DOI: 10.4103/aca.aca_145_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Vascular compression of the esophagus by an aberrant right subclavian artery (aRSA) leading to dysphagia is a rare occurrence. There has been a significant advancement in the diagnostic and surgical treatment modalities available for this disorder. Anesthetic management has evolved too and this case report highlights the anesthetic management of a 41-year-old woman presenting with symptoms of dysphagia because of compression of esophagus by an aRSA, who subsequently underwent re-implantation of aRSA into ascending aorta.
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34
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Li T, Zou L, Feng Y, Fan G, Xin Y. Hybrid repair of aberrant right subclavian artery with aortic dissection caused by Kommerell diverticulum. BMC Cardiovasc Disord 2021; 21:562. [PMID: 34809569 PMCID: PMC8607728 DOI: 10.1186/s12872-021-02340-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/22/2021] [Indexed: 11/22/2022] Open
Abstract
Background Aberrant right subclavian artery (ARSA) with associated Kommerell diverticulum (KD) is a rare congenital aortic disease. KD patients have a high risk of rupture, dissection, and compression of adjacent structures. Although several treatment options have been proposed (traditional surgery, hybrid operation, and endovascular intervention), a consensus regarding optimal surgical management has not yet been established. Case presentation A case of successful hybrid repair of distal aortic arch dissection aneurysm by dissecting KD and ARSA with debranching of right and left common carotid arteries, left subclavian artery, and stent grafting was presented. Conclusions The hybrid operation is suitable for elderly patients or those with high risks. Along with intervention, the hybrid operation needs to be developed as a minimally invasive method.
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Affiliation(s)
- Tieyan Li
- Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People's Republic of China.,Shanghai Engineering Research Center of Artificial Heart and Heart Failure Medicine, Shanghai, 200120, People's Republic of China
| | - Lin Zou
- Department of Endocrinology, Shanghai Pudong New Area Gongli Hospital, Shanghai, 200135, People's Republic of China
| | - Yunzhen Feng
- Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People's Republic of China
| | - Guoliang Fan
- Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People's Republic of China
| | - Yuanfeng Xin
- Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People's Republic of China.
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35
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Arteria lusoria - a rare cause of dysphagia or a common accidental finding? COR ET VASA 2021. [DOI: 10.33678/cor.2021.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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36
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Abstract
Dysphagia has several typical causes. In this case report a young adult with difficulties in swallowing since childhood is diagnosed with a rare anatomical variation of the aortal branches.
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Affiliation(s)
- Sarah S Jakobsen
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Jens B Frøkjaer
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Anders C Larsen
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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37
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Buffoli B, Verzeletti V, Hirtler L, Rezzani R, Rodella LF. Retroesophageal right subclavian artery associated with a bicarotid trunk and an ectopic origin of vertebral arteries. Surg Radiol Anat 2021; 43:1491-1495. [PMID: 33856505 PMCID: PMC8408090 DOI: 10.1007/s00276-021-02746-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/01/2021] [Indexed: 11/29/2022]
Abstract
A rare branching pattern of the aortic arch in a female cadaver is reported. An aberrant right subclavian artery originated from the distal part of the aortic arch and following a retroesophageal course was recognized. Next to it, from the left to the right, the left subclavian artery and a short bicarotid trunk originating the left and the right common carotid artery were recognized. An unusual origin of the vertebral arteries was also identified. The left vertebral artery originated directly from the aortic arch, whereas the right vertebral artery originated directly from the right common carotid artery. Retroesophageal right subclavian artery associated with a bicarotid trunk and ectopic origin of vertebral arteries represents an exceptional and noteworthy case.
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Affiliation(s)
- Barbara Buffoli
- Division of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, V.le Europa 11, 25123, Brescia, Italy. .,Interdepartmental University Center of Research "Adaption and Regeneration of Tissues and Organs (ARTO)", University of Brescia, Brescia, Italy.
| | - Vincenzo Verzeletti
- Division of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, V.le Europa 11, 25123, Brescia, Italy
| | - Lena Hirtler
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Rita Rezzani
- Division of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, V.le Europa 11, 25123, Brescia, Italy.,Interdepartmental University Center of Research "Adaption and Regeneration of Tissues and Organs (ARTO)", University of Brescia, Brescia, Italy
| | - Luigi Fabrizio Rodella
- Division of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, V.le Europa 11, 25123, Brescia, Italy.,Interdepartmental University Center of Research "Adaption and Regeneration of Tissues and Organs (ARTO)", University of Brescia, Brescia, Italy
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Ndiaye K, Abbassi A, Traoré S, Vagba J, Aouami A, Berret M. [Arteria lusoria causing dyspnea: about a case]. Pan Afr Med J 2020; 37:318. [PMID: 33654537 PMCID: PMC7896518 DOI: 10.11604/pamj.2020.37.318.23253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 05/10/2020] [Indexed: 12/03/2022] Open
Abstract
Arteria lusoria or retroesophageal right subclavian artery is the most common aortic arch malformation, accounting for 0.5-2.5% of cases. It can be detected in patients with symptoms including airway and/or esophageal compression such as dyspnea or dysphagia or even recurrent respiratory infections; but it is mostly asymptomatic, as reported by several authors. We here report the case of a 44-year-old female patient treated in our emergency room due to respiratory distress syndrome associated with arteria lusoria. This is a rare cause of dyspnea which should be suspected in patients with dyspnea not responding to medical treatment. Asymptomatic patients undergo medical treatment associated with simple surveillance. Surgery is necessary when it becomes symptomatic or when it is associated with Kommerell diverticulum (KD).
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Affiliation(s)
- Kader Ndiaye
- Service d´Anesthésie et Réanimation, Centre Hospitalo-Universitaire la Renaissance, N´Djamena, Tchad
| | - Adamou Abbassi
- Service d´Anesthésie et Réanimation, Centre Hospitalo-Universitaire la Renaissance, N´Djamena, Tchad
| | - Sory Traoré
- Service d´Anesthésie et Réanimation, Centre Hospitalo-Universitaire la Renaissance, N´Djamena, Tchad
| | - Jacob Vagba
- Service d´Anesthésie et Réanimation, Centre Hospitalo-Universitaire la Renaissance, N´Djamena, Tchad
| | - Aboubacar Aouami
- Service de Radiologie et Imagerie Médicale, Centre Hospitalo-Universitaire la Renaissance, N´Djamena, Tchad
| | - Martine Berret
- Service d´Anesthésie et Réanimation, Centre Hospitalo-Universitaire la Renaissance, N´Djamena, Tchad
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Abstract
The term right aortic arch is used for an aorta that arches over the right bronchus. Right aortic arch was classified into two types by Felson et al, based on branching patterns, with a proposed embryological explanation, and into three types by Shuford et al. Other anatomical variants of right aortic arch were described later, including isolated left brachiocephalic artery and aberrant left brachiocephalic artery. We have classified right aortic arch anatomy into 10 variants, supported by radiological evidence, and with reference to possible embryology. This classification will help in understanding the morphological basis for the formation of different types of right aortic arch and the course of the recurrent laryngeal nerve in such cases.
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40
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Kassif E, Tsur A, Shust-Barequet S, Raviv O, Kushnir A, Abu Snenh S, Achiron R, Mazaki-Tovi S, Weisz B, Salem Y, Weissbach T. The “No ARSA” Sign: A Novel Method of Prenatal Screening for Aberrant Right Subclavian Artery. J Clin Med 2020; 9:jcm9082658. [PMID: 32824459 PMCID: PMC7463697 DOI: 10.3390/jcm9082658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/06/2020] [Accepted: 08/12/2020] [Indexed: 12/25/2022] Open
Abstract
An aberrant right subclavian artery (ARSA) can be overlooked by the conventional method as described by Chaoui et al., due to acoustic shadowing. The aim of this study was to evaluate the feasibility and accuracy of a novel screening method for ARSA by demonstrating the brachiocephalic artery bifurcation, referred to as the “No ARSA” sign. A prospective study conducted at a tertiary care center between 2018 and 2019 included unselected pregnant patients at a median gestational age of 15.1 (14.2–22.1; IQR (inter-quartile range)) weeks, who had been referred for a routine or targeted anomaly scan. All participants were scanned for the presence or absence of ARSA using both the conventional and the novel “No ARSA” methods for validation purposes. A total of 226 unselected patients were enrolled in the study. The “No ARSA” sign was visualized in 218 fetuses (96.5%). In the remaining 8 cases (3.5%), the “No ARSA” sign was not demonstrated. In these fetuses, an ARSA was visualized by the conventional method. The new method exhibited 100% feasibility and was in complete agreement with the conventional method. Intra- and inter-observer agreement was excellent (κ = 1). The results of the study suggest that the “No ARSA” sign is an efficient and reliable screening tool for ARSA.
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Affiliation(s)
- Eran Kassif
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Abraham Tsur
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Shir Shust-Barequet
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Oshrat Raviv
- Departments of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
| | - Anya Kushnir
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Samar Abu Snenh
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Reuven Achiron
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Shali Mazaki-Tovi
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Boaz Weisz
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Yishay Salem
- Pediatric Cardiology Unit, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Correspondence: (Y.S.); (T.W.); Tel.: +972-546-250-299 (T.W.)
| | - Tal Weissbach
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
- Correspondence: (Y.S.); (T.W.); Tel.: +972-546-250-299 (T.W.)
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41
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Wang P, Wang Q, Bai C, Zhou P. Iatrogenic aortic dissection following transradial coronary angiography in a patient with an aberrant right subclavian artery. J Int Med Res 2020; 48:300060520943789. [PMID: 32787591 PMCID: PMC7427028 DOI: 10.1177/0300060520943789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
An aberrant right subclavian artery is a congenital aortic arch anomaly in which the right subclavian artery originates from the proximal descending aorta. The presence of an aberrant right subclavian artery can make right transradial coronary interventions more difficult and even lead to complications. Iatrogenic intramural hematomas and dissection of aberrant right subclavian arteries during transradial coronary angiography have been previously reported. We herein report a case of iatrogenic aortic dissection following attempts to perform right transradial coronary angiography in a patient with an aberrant right subclavian artery. Clinicians should be vigilant for the presence of an aberrant right subclavian artery during right transradial coronary angiography and ensure gentle manipulation of wires and catheters to avoid complications.
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Affiliation(s)
- Peijian Wang
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan, China
| | - Qiulin Wang
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan, China
| | - Chen Bai
- Department of Imaging, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan, China
| | - Peng Zhou
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan, China
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42
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Kang G, Lee J, Song T, Pantelic M, Reeser N, Keimig T, Nadig J, Villablanca P, Frisoli T, Eng M, O'Neill WW, Wang DD. 3-Dimensional CT Planning for Cerebral Embolic Protection in Structural Interventions. JACC Cardiovasc Imaging 2020; 13:2673-2676. [PMID: 32563641 DOI: 10.1016/j.jcmg.2020.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Guson Kang
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - James Lee
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Thomas Song
- Department of Radiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Milan Pantelic
- Department of Radiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Nicholas Reeser
- Department of Radiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Thomas Keimig
- Department of Radiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Jeffrey Nadig
- Department of Radiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Pedro Villablanca
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Tiberio Frisoli
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Marvin Eng
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - William W O'Neill
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Dee Dee Wang
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA.
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43
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Jha N, Selkirk G, Crockett MT, Phillips TJ. Transradial intracranial aneurysm treatment via an aberrant right subclavian artery. BMJ Case Rep 2020; 13:13/6/e234078. [PMID: 32522721 DOI: 10.1136/bcr-2019-234078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report two cases of successfully treated intracranial saccular aneurysms via transradial access with aberrant right subclavian artery anatomy. Two patients aged 74 and 82 years with anterior communicating artery aneurysms deemed suitable for endovascular treatment and anomalous aortic arch anatomy (aberrant right subclavian artery) underwent successful treatment with transradial access. Transradial access was obtained in both patients, in the first patient, without prior knowledge of the aortic arch anatomy. Aberrant right subclavian artery anatomy was negotiated, and the aneurysms were successfully treated in both cases with intrasaccular flow disrupting devices (WEB-SL).
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Affiliation(s)
- Nihar Jha
- Neurological Imaging and Interventional Service of Western Australia, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Gregory Selkirk
- Neurological Imaging and Interventional Service of Western Australia, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Matthew Thomas Crockett
- Neurological Imaging and Interventional Service of Western Australia, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Timothy John Phillips
- Neurological Imaging and Interventional Service of Western Australia, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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44
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Xiong S, Wang D, Li J. Endovascular repair of type A aortic intramural hematoma accompanied by aberrant right subclavian artery and Kommerell's diverticulum: a case report. BMC Cardiovasc Disord 2020; 20:220. [PMID: 32404054 PMCID: PMC7218650 DOI: 10.1186/s12872-020-01504-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background The lesions of aberrant right subclavian artery, Kommerell’s diverticulum and type A aortic intramural hematoma are rare, and we usually treat them with open surgery. In some cases patients have increased risk to undergo surgery, the experiences of endovascular or medical treatment are limited. Case presentation Here we reported a case of a 53-year-old man with these three entities present with chest and back ache and attempted a novel approach, thoracic endovascular aortic repair, in the absence of surgical treatment. The patient lived over 5 years and this case provides initial experience and lesson about the endovascular and medical management of the uncommon and dangerous disease- type A aortic intramural hematoma with aortic congenital malformation. Conclusion Thoracic endovascular aortic repair with medical treatment may be a potential alternative approach for type A aortic intramural hematoma.
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Affiliation(s)
- Sizheng Xiong
- Division of Cardiothoracic and vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Daoquan Wang
- Division of Cardiothoracic and vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Jun Li
- Division of Cardiothoracic and vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China.
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Abstract
Dysphagia lusoria is rare embryologic defect of the aortic arch vasculature characterized by an aberrant retro-esophageal course of the right subclavian artery (RSA), comprising a vascular sling. This may manifest clinically with symptoms of dysphagia or reflux. Given the rarity of this pathology, there remains uncertainty regarding the most effective treatment algorithm. Vascular decompression procedure surgery is often used to rectify the aberrant vascular morphology. However, a low percentage of aberrant arteries result in trachea-esophageal symptoms. As such, we suggest (1) one must exclude co-morbid esophageal motility disorders in patients with dysphagia; and (2) aberrant RSA may be a cause of dysphagia, so-called dysphagia lusoria, but represents an unlikely mechanism, since this morphological arrangement typically does not result in a highly constrictive, circumferential vascular ring. It follows, therefore, that directly addressing the esophageal motility issue should take precedence over complex and potentially noncurative vascular procedures directed to the aberrant RSA. However, the presence of marked aneursymal dilation of the aberrant RSA, and/or the presence of a bicarotid (socalled bovine) trunk, would favor vascular repair in the clinical decision-making due to the elevated risk of rupture and more severe esophageal compression in these specific situations.
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Affiliation(s)
- Michael Coles
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA.
| | - Amol Sharma
- Division of Gastroenterology & Hepatology, Medical College of Georgia, Augusta University, Augusta, GA, USA
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46
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Plotkin A, Ng B, Han SM, Weaver FA, Ham SW, Bowdish ME, Wilcox AG, Magee GA. Association of aberrant subclavian arteries with aortic pathology and proposed classification system. J Vasc Surg 2020; 72:1534-1543. [PMID: 32238310 DOI: 10.1016/j.jvs.2020.01.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Aberrant subclavian artery (aSCA) is a rare anatomic variant whose association with other aortic branch variations and aortic pathology has yet to be established. Knowledge of such an association could be relevant to recommendations for screening and awareness as associated variations are important for operative planning. We describe the incidence of aSCA variations, its association with aortic pathology, and a proposed classification system. METHODS The thoracic cross-sectional imaging database at Keck Hospital of the University of Southern California from 2006 to 2018 was queried for presence of aSCA. Studies were evaluated for aSCA laterality, variant anatomy, and aortic and branch vessel disease. Medical records were reviewed for associated symptoms and diagnoses. The primary outcome was association of aSCA with aortic pathology (aneurysm or dissection). Secondary outcomes were comparison of right and left aSCA, comparison between the sexes, and creation of a proposed classification system. RESULTS Of 98,580 axial imaging studies, 810 studies (0.82%) were identified with aSCA in 312 unique patients. Right aSCA made up the majority of cases (90.1%). All aSCAs had a retroesophageal course. Kommerell's diverticulum (KD) was present in 184 (59%) with an average diameter of 1.67 cm (range, 1.2-3.3 cm). KD was more frequent (84% vs 56%; P = .0003) and larger (2.05 cm vs 1.61 cm; P < .0001) in left aSCA patients. When present, KD was more often symptomatic in left aSCA compared with right aSCA (77.4% vs 49.1%; P = .005). Dysphagia, chest pain, reflux, and asthma were all more common in left aSCA patients. KD was also more common in men (73.3% vs 50%; P < .0001) and larger in men (1.81 cm vs 1.54 cm; P < .0001) but with no difference in symptoms between sexes. Our proposed classification system based on aortic arch branching is as follows: type 1, left arch with right aSCA (59.9%); type 2, left arch with common carotid trunk and right aSCA (30.1%); type 3, right arch with left aSCA (9.6%); and type 4, right arch with common carotid trunk and left aSCA (0.3%). Subtypes describe the right vertebral artery (RVA) and left vertebral artery (LVA) origin: subclavian (s, RVA 90.1%, LVA 96.8%), carotid (c, RVA 9.6%, LVA 0.3%), or arch (a, RVA 0.3%, LVA 2.9%). Overall, 9.9% (31/312) had associated aortic pathology, although the study was underpowered to detect a difference between right aSCA and left aSCA (9.3% vs 16.1%; P = .213). Type 3 and type 4 arches more often have associated aortic pathology, KD, and symptoms. CONCLUSIONS aSCAs are frequently symptomatic and commonly associated with aortic dissection and aneurysm. Our proposed classification scheme depicts all four aSCA arch variants and accounts for vertebral artery origin variation. These variants are common, and vertebral anatomy can differ greatly. Knowledge of these anatomic variations is critical to planning for endovascular and open repair of aortic arch pathology.
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Affiliation(s)
- Anastasia Plotkin
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Brian Ng
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Sukgu M Han
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Fred A Weaver
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Sung W Ham
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Michael E Bowdish
- Division of Cardiothoracic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Alison G Wilcox
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Gregory A Magee
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif.
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47
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Kchir H, Hassine A, Gharbi O, Ridene I, Maamouri N. [A rare cause of dysphagia: Plummer Vinson syndrome associated with arteria lusoria]. Presse Med 2019; 48:1582-1584. [PMID: 31703955 DOI: 10.1016/j.lpm.2019.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 06/12/2019] [Accepted: 08/27/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Hela Kchir
- Hôpital La Rabta, service de gastroentérologie B, Tunis, Tunisie.
| | - Amira Hassine
- Hôpital La Rabta, service de gastroentérologie B, Tunis, Tunisie
| | - Ons Gharbi
- Hôpital La Rabta, service de gastroentérologie B, Tunis, Tunisie
| | - Imene Ridene
- Hôpital Mahmoud El Matri, service de radiologie, Ariana, Tunisie
| | - Nadia Maamouri
- Hôpital La Rabta, service de gastroentérologie B, Tunis, Tunisie
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48
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Sun YY, Zhang GM, Zhang YB, Du X, Su ML. Bilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome: A case report. World J Clin Cases 2019; 7:3639-3648. [PMID: 31750348 PMCID: PMC6854396 DOI: 10.12998/wjcc.v7.i21.3639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 09/23/2019] [Accepted: 09/25/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND We report a rare case of numbness in the right hand, finally diagnosed as bilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome and explain the cause of these diseases.
CASE SUMMARY The patient was a 65-year-old woman. She complained of dizziness, numbness and weakness of the right hand for 6 mo. She was diagnosed with bilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome by ultrasound, enhanced computed tomography, computed tomography angiography and other examinations. Considering the surgical risks, the patient refused the aberrant right subclavian artery stent implantation and was discharged. We hypothesize that these two kinds of deformity and right subclavian steal syndrome may not occur by accident and result from multiple malformations.
CONCLUSION Bilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome is rare. This case reminds interventional radiologists of the possibility of these abnormalities before surgery.
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Affiliation(s)
- Yuan-Yuan Sun
- Department of Ultrasound, Xiamen Cardiovascular Hospital Xiamen University, Xiamen 361000, Fujian Province, China
| | - Guo-Ming Zhang
- Department of Cardiology, Xiamen Cardiovascular Hospital Xiamen University, Xiamen 361000, Fujian Province, China
| | - You-Bin Zhang
- Department of Radiology, Zhongshan Hospital Xiamen University, Xiamen 361000, Fujian Province, China
| | - Xin Du
- Department of Ultrasound, Xiamen Cardiovascular Hospital Xiamen University, Xiamen 361000, Fujian Province, China
| | - Mao-Long Su
- Department of Ultrasound, Xiamen Cardiovascular Hospital Xiamen University, Xiamen 361000, Fujian Province, China
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49
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Lam K, Tan EW, Lee JC. Case of dysphagia lusoria in a patient with a non-recurrent laryngeal nerve. ANZ J Surg 2019; 90:1487-1489. [PMID: 31647167 DOI: 10.1111/ans.15530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Kenneth Lam
- Department of Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Elizabeth W Tan
- Department of Surgery, Monash Health, Melbourne, Victoria, Australia
| | - James C Lee
- Department of Surgery, Monash Health, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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50
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Baig A, Fortner C, Rivera M, Merrow J, Gupta S, Sher E, Mortelliti A. Vascular anomaly: Cause of infant respiratory distress and dysphagia. Respir Med Case Rep 2019; 28:100908. [PMID: 31367518 PMCID: PMC6656703 DOI: 10.1016/j.rmcr.2019.100908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/21/2019] [Accepted: 07/15/2019] [Indexed: 11/28/2022] Open
Abstract
Aberrant right subclavian artery with a left aortic arch is rare, but it is the most common congenital aortic arch anomaly. It can present as an incidental finding later in life or be symptomatic at a young age. Here, we describe a case of an aberrant right subclavian artery discovered in a 4 month old with respiratory distress and feeding difficulties. She underwent an extensive aerodigestive evaluation including bronchoscopy, both flexible and rigid, upper GI endoscopy, modified barium swallow with esophageal sweep, chest imaging, CT thorax and echocardiogram. The final decision per the management team was to observe the patient in order to allow more growth. She ultimately improved with age and remains asymptomatic.
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Affiliation(s)
- Aisha Baig
- Department of Pediatrics, Pulmonary Division, Upstate University/Golisano Children's Hospital, Syracuse, NY, USA.,Rutgers University/Robert Wood Johnson Hospital New Brunswick, NJ, USA
| | - Christopher Fortner
- Department of Pediatrics, Pulmonary Division, Upstate University/Golisano Children's Hospital, Syracuse, NY, USA
| | - Marcus Rivera
- Department of Pediatrics, Gastroenterology Division, Upstate University/Golisano Children's Hospital, Syracuse, NY, USA
| | - Jill Merrow
- Upstate University/Golisano Children's Hospital, Syracuse, NY, USA
| | - Saurabh Gupta
- Pediatric Radiology, SUNY Upstate Medial University/Golisano Children's Hospital, Syracuse, NY, USA
| | - Erica Sher
- PGY-4, Otolaryngology/Head and Neck surgery, SUNY Upstate Medial University/Golisano Children's Hospital, Syracuse, NY, USA
| | - Anthony Mortelliti
- Otolaryngology and Communication sciences, SUNY Upstate Medial University/Golisano Children's Hospital, Syracuse, NY, USA
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