Extraanatomical reconstruction for bilateral intrathoracic subclavian artery aneurysms

The Versatility of Gore Tex® Grafts for Extra-Anatomic Bypass

Fifty six patients underwent fifty nine complex extra-anatomic revascular ization procedures using Gore Tex®. Nine grafts (15%) occluded. We opted not to revise 2 grafts and other two grafts thrombectomized ultimately failed. Five grafts were declotted and have remained patent.

The other patients have patent grafts or died of their primary illness with patent grafts (overall patency 93%). The surviving patients have been followed for an average period of 27.7 months (0.5-56 mo.).

Based on this experience we conclude that Gore Tex®, is a suitable conduit for complex extra-anatomic bypass in patients whose condition contraindicates direct vascular reconstruction.

Covered stents for true subclavian aneurysms in patients with degenerative connective tissue disorders

PURPOSE

To report the endovascular repair of rare true aneurysms of the subclavian artery in patients with degenerative connective tissue disorders.

CASE REPORTS

Two patients, one with Marfan syndrome and the other with idiopathic cystic medial necrosis, presented with 3 subclavian artery aneurysms. A Wallgraft and 2 Viabahn covered stents were used to successfully exclude these aneurysms. After 3 months, the Wallgraft thrombosed, but the contralateral Viabahn remained patent at the most recent examination 13 months after treatment. The other patient with the unilateral aneurysm had a patent Viabahn stent-graft at 10 months.

CONCLUSIONS

Patients with degenerative connective tissue disorders may benefit from less invasive treatment with stent-grafts. The more flexible Viabahn stent-graft may be better able to adapt to arterial tortuosity. However, the long-term results of this new technique have not yet been established.

Mycotic aneurysm of the left subclavian artery presented with hemoptysis in an immunosuppressed man: case report and review of literature

We report the case of a 32-year-old man with a mycotic aneurysm of the left subclavian artery. This patient had immunosuppression caused by chemotherapy administered for treatment of leukemia. This aneurysm was revealed by two episodes of hemoptysis caused by a lung parenchyma fistulization. The patient was treated successfully by simple ligation and exclusion via a thoracotomy with partial lung resection. Histologic examination confirmed the presence of aspergilloma filaments in the false aneurysm. We suspect that aspergilloma could have been the cause of the mycotic aneurysm in this particular case. The literature on subclavian artery mycotic aneurysms is reviewed.

Atherosclerotic aneurysm of the intrathoracic subclavian artery: a case report and review of the literature

True aneurysm of the subclavian artery is extremely rare. Excluding the more common aneurysms of an aberrant right subclavian artery, those associated with thoracic outlet syndrome, and posttraumatic "aneurysms," atherosclerosis is the most common cause. Syphilis, tuberculosis, and cystic medial necrosis are less often the cause. These aneurysms can rupture, thrombose, embolize, or cause symptoms by local compression. Surgical treatment is generally indicated, and has evolved from ligation procedures to extirpation or endoaneurysmorrhaphy to the present practice of resection with revascularization. A case of a surgically treated, asymptomatic, atherosclerotic aneurysm of the intrathoracic left subclavian artery is presented, with a review of the English-language literature on the subject.

Massive hemoptysis caused by a ruptured subclavian artery aneurysm

We report a case of left subclavian artery aneurysm, which ruptured and penetrated through the left upper lung parenchyma causing massive hemoptysis and a left hemothorax. Through sternothoracotomy, tangential aneurysmorrhaphy under proximal control and left upper pulmonary lobectomy were performed. The patient is doing well after nearly three years of follow-up.