1
|
Huang L, Lu J, Wang Z. Application of the "Hand as Foot" analogy teaching method in aberrant right subclavian artery. Asian J Surg 2024:S1015-9584(24)01341-1. [PMID: 39003149 DOI: 10.1016/j.asjsur.2024.06.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 06/28/2024] [Indexed: 07/15/2024] Open
Affiliation(s)
- Legang Huang
- Department of Vascular Intervention, ShengLi Oilfield Center Hospital, Dongying, China.
| | - Jiankuan Lu
- Department of Vascular Intervention, ShengLi Oilfield Center Hospital, Dongying, China.
| | - Zijie Wang
- Department of Vascular Intervention, ShengLi Oilfield Center Hospital, Dongying, China.
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Upper Gastrointestinal Bleeding From Aberrant Right Subclavian Artery-Esophageal Fistula. Ochsner J 2022; 21:406-412. [PMID: 34984057 PMCID: PMC8675615 DOI: 10.31486/toj.20.0142] [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: 11/08/2022] Open
Abstract
Background: The most common aortic arch abnormality is an aberrant right subclavian artery (ARSA). ARSA-esophageal fistula is a rare sequela that can present with a life-threatening upper gastrointestinal (GI) bleed. Case Report: We report the case of an 88-year-old male who presented with signs of upper GI bleeding. Esophagogastroduodenoscopy demonstrated extrinsic compression of the upper third of the esophagus with ulceration. Imaging studies revealed ARSA posterior to the esophagus with pseudoaneurysm formation. These findings confirmed an upper GI bleed secondary to ARSA-esophageal fistula. The patient underwent prompt embolization of the ARSA pseudoaneurysm, followed a few days later by coil embolization of the ARSA pseudoaneurysm. Despite these interventions, the patient continued to have bleeding with anemia. He and his family opted to avoid any further interventions and instead pursued comfort care. The patient was discharged to hospice and died 3 months later. Conclusion: ARSA-esophageal fistula is a rare but potentially lethal cause of upper GI bleeding. Initial signs and symptoms can be subtle, but the presence of a GI bleed requires immediate stabilization. Surgical interventions have been shown to have longer-lasting success, but endovascular repair may be an option for patients who are deemed unfit for surgery but still require prompt stabilization. Regardless of the intervention, mortality rates for ARSA-esophageal fistula are high.
Collapse
|
4
|
An Elegant Solution to a Ruptured Right Aberrant Subclavian Artery after Oesophageal Stent Removal. Case Rep Vasc Med 2021; 2021:8891012. [PMID: 33936832 PMCID: PMC8055437 DOI: 10.1155/2021/8891012] [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: 07/14/2020] [Accepted: 04/01/2021] [Indexed: 11/17/2022] Open
Abstract
Arterioenteric or arteriotracheal fistula is a known complication of an aberrant right subclavian artery (ARSA) and is often associated with prolonged nasogastric or endotracheal intubation or oesophageal stenting. Fistula formation from the ARSA can present unexpectedly with rapid exsanguination with massive haemoptysis or haematemesis, and unless promptly recognised and treated is rapidly fatal. We present a novel endovascular method for treating a fistula between the oesophagus, trachea and an ARSA in an unstable patient following oesophageal stent removal, utilising a covered iliac limb stent, eliminating the need for an open surgical approach.
Collapse
|
5
|
Kim S, Jeon KN, Bae K. Aberrant Left Subclavian Artery-Esophageal Fistula in a Patient with a Prolonged Use of Nasogastric Tube: A Case Report and Literature Review. Diagnostics (Basel) 2021; 11:diagnostics11020195. [PMID: 33525727 PMCID: PMC7911238 DOI: 10.3390/diagnostics11020195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 01/06/2023] Open
Abstract
Arterial-esophageal fistula is a rare but potentially fatal complication. Right aortic arch with aberrant left subclavian artery is a rare congenital vascular anomaly that can cause esophageal compression, particularly when the proximal portion of the aberrant subclavian artery forms a Kommerell's diverticulum. Prolonged use of a nasogastric tube can cause pressure necrosis of the esophagus. We report a patient with massive gastrointestinal bleeding secondary to aberrant left subclavian artery-esophageal fistula after a prolonged use of nasogastric tube. A high index of suspicion is essential for better prognosis when a patient with congenital aortic arch anomaly shows upper gastrointestinal hemorrhage.
Collapse
Affiliation(s)
- Sungbin Kim
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju 52727, Korea; (S.K.); (K.B.)
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon 51472, Korea
| | - Kyung Nyeo Jeon
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju 52727, Korea; (S.K.); (K.B.)
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon 51472, Korea
- Correspondence: ; Tel.: +82-55-214-3896
| | - Kyungsoo Bae
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju 52727, Korea; (S.K.); (K.B.)
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon 51472, Korea
| |
Collapse
|
6
|
Fachin CG, Demartini Z, Pinto ASA, Klüppel EN, Teixeira BCDA, Bischoff C, Bonin EA, Dias AIBDS. Carotid-Esophageal Fistula Treated By Endovascular Approach. Vasc Endovascular Surg 2020; 55:419-421. [PMID: 33375907 DOI: 10.1177/1538574420976732] [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: 11/15/2022]
Abstract
The carotid-esophageal fistula is a rare and serious complication of the metallic esophageal prosthesis. A high index of suspicion is required for early diagnosis and treatment, decreasing the morbidity and mortality rate of this severe complication. We report a case of a 4-year-old boy presenting severe upper gastrointestinal bleeding due to a carotid-esophageal fistula, secondary to deployment of an esophageal metallic prosthesis for treatment of a recurrent stenosis. The carotid pseudo-aneurism was successfully treated with stents and coils. Although endovascular treatment is a safe and effective option, arterial stenting in children needs further studies with long-term follow-up.
Collapse
Affiliation(s)
- Camila Girardi Fachin
- Department of Pediatric Surgery, 274922Federal University of Paraná-Rua Padre Camargo, Curitiba, Parana, Brazil
| | - Zeferino Demartini
- Department of Neurosurgery, 274922Federal University of Paraná-Rua Padre Camargo, Curitiba, Parana, Brazil
| | - Amanda Satuti Alcure Pinto
- Department of Pediatric Surgery, 274922Federal University of Paraná-Rua Padre Camargo, Curitiba, Parana, Brazil
| | - Elis Novochadlo Klüppel
- Hospital de Clínicas and Medical School, 274922Federal University of Paraná-Rua Padre Camargo, Curitiba, Parana, Brazil
| | | | - Cristiano Bischoff
- Department of Pediatric Surgery, 274922Federal University of Paraná-Rua Padre Camargo, Curitiba, Parana, Brazil
| | - Eduardo Aimore Bonin
- Gastrointestinal Endoscopy Unit, 274922Federal University of Paraná-Rua Padre Camargo, Curitiba, Parana, Brazil
| | | |
Collapse
|
7
|
Liu MC, Wang YS, Yang YJ, Lai FP. Case Report: Successful Use of Biliary Stent for Iatrogenic Esophageal Perforation Following Balloon Dilation in a 7-Month-Old Infant. Front Pediatr 2020; 8:545760. [PMID: 33194887 PMCID: PMC7655732 DOI: 10.3389/fped.2020.545760] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 10/06/2020] [Indexed: 11/17/2022] Open
Abstract
Esophageal perforation is a rare but critical emergency that requires early detection and prompt management. In the pediatric population, iatrogenic injury is the most common etiology of esophageal perforation, and the majority of cases come from stricture dilation. Treatment options include medical management, endoscopic therapy, and surgery. Usually, conservative treatment is appropriate in most carefully selected patients, especially in the setting of early diagnosis and with the absence of severe sepsis. A surgical approach is reserved for a large tear with mediastinum contamination, or clinical deterioration after unsuccessful conservative management. With the advancement of the endoscopy technique, endoscopy therapy using esophageal stents is an available choice for adult populations who have a complicated protracted healing course or comorbidities precluding surgical attempts. However, this procedure is seldom implemented in children, especially in young infants, owing to unavailable equipment and experts. We report our successful use of a fully-covered self-expandable metal biliary stent in managing esophageal perforation in a seven-month-old infant. In light of this encouraging achievement, this model can be applied to more children who have the same problem.
Collapse
Affiliation(s)
- Meng-Chuan Liu
- Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yao-Sheng Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yao-Jong Yang
- Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
- Institute of Clinical Medicine, Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Fu-Ping Lai
- Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
| |
Collapse
|