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Requejo-Garcia L, Martinez-Lopez R, Plana-Andani E, Medina P, Hernandiz-Martinez A, Miralles-Hernández M. Extra-Thoracic Aneurysms in Marfan Syndrome: A Systematic Review of the Literature. Ann Vasc Surg 2022; 87:548-559. [PMID: 36029951 DOI: 10.1016/j.avsg.2022.08.005] [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: 03/30/2022] [Revised: 07/31/2022] [Accepted: 08/07/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Marfan syndrome (MS) most often shows as thoracic aortic aneurysm (TAA) or aortic dissection, but it may also involve other vascular territories. OBJECTIVE To identify those extra-thoracic vascular manifestations most frequently associated with MS. METHODOLOGY Systematic review of the literature with PRISMA criteria. The following databases were included: Medline, Embase, Web of Science (WOS), Cumulative Index of Nursing and Health Sciences Literature (CINHAL); Spanish database MEDESY Cochrane Central Register of Controlled Trials (CENTRAL). RESULTS 10,008 articles were identified, leaving 155 for the first stage of data analysis (total incidence of aneurysms) and 83 for the second (descriptive data analysis). Overall, 518 aneurysms were identified: 149 in the head and neck, 94 in the extremities 275 in the aortic, iliac and visceral sectors. Mostly, they were simultaneously discovered during studies of the AAT. In the abdominal aorta, the presentation with rupture in 11 of 32 patients stands out. Resection and bypass was the most frequently used method for repair in the treated cases. CONCLUSIONS Although its frequency in the general population is unknown, this systematic review suggests that extra-thoracic aneurysmal arterial involvement in the MS may be more frequent than expected. We believe screening for aneurysms in other vascular sectors may be advisable, especially in patients with MS and AAT.
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Affiliation(s)
- L Requejo-Garcia
- Angiology and Vascular Surgery Department. Hospital Universitario de La Ribera, Alzira, Valencia
| | - R Martinez-Lopez
- Angiology and Vascular Surgery Department. Hospital Universitario y Politécnico La Fe, Valencia
| | - E Plana-Andani
- Angiology and Vascular Surgery Department. Hospital Universitario y Politécnico La Fe, Valencia; Research Group on hemostasis, Thrombosis, Arteriosclerosis and Vascular Biology. Instituto de Investigación Sanitara-Hospital La Fe, Valencia
| | - P Medina
- Research Group on hemostasis, Thrombosis, Arteriosclerosis and Vascular Biology. Instituto de Investigación Sanitara-Hospital La Fe, Valencia
| | - A Hernandiz-Martinez
- Research Group on Regeneration and Heart Transplantation. Instituto de Investigación Sanitara-Hospital La Fe, Valencia
| | - M Miralles-Hernández
- Angiology and Vascular Surgery Department. Hospital Universitario y Politécnico La Fe, Valencia; Research Group on hemostasis, Thrombosis, Arteriosclerosis and Vascular Biology. Instituto de Investigación Sanitara-Hospital La Fe, Valencia.
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Claviculectomy for exposure and redo repair of expanding, recurrent right subclavian aneurysm. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:694-697. [PMID: 34746533 PMCID: PMC8556485 DOI: 10.1016/j.jvscit.2021.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022]
Abstract
Subclavian artery aneurysms (SAAs) are rare, and their repair can be technically complex. We have reported the redo repair of a large, expanding, right SAA after primary repair consisting of total aortic arch replacement with bilateral subclavian artery ligation and bypass. The redo repair used claviculectomy to facilitate exposure, ligation of the right deep cervical and internal thoracic arteries from within the aneurysm sac, and revision of the previous axillary artery bypass that had thrombosed owing to the mass effect of the expanding SAA. Claviculectomy can facilitate repair of large SAAs that are poorly suited to more routine exposure approaches, with acceptable risk and functional outcomes.
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Sun J, Qi H, Shi Y, Guo H, Shen C, Ouyang C, Qian X. Isolated True Subclavian Aneurysm without Aberrant Subclavian Artery or Coarctation of Descending Aorta. Ann Vasc Surg 2021; 75:294-300. [PMID: 33819595 DOI: 10.1016/j.avsg.2021.01.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/02/2020] [Accepted: 01/29/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Isolated true subclavian artery aneurysm (SAA) without aberrant subclavian artery or coarctation of descending aorta is a rare peripheral aneurysm. Herein, the experience of our medical center in the treatment of this disease is presented. METHODS The Division operative log was queried to identify cases of SAA repair between January 2012 and September 2019 that were not associated with coarctation of the aorta or the presence of an aberrant subclavian artery. A total of 22 cases were identified. The characteristics, treatment and clinical outcomes of these cases were assessed. RESULTS The mean age of patients was 53.5 ± 14.3 years and 14 patients were male (63.6%). Half of the cases were attributed to atherosclerotic degeneration. The clinical symptoms of aneurysms were varied, including asymptomatic, pulsatile mass of supraclavicular fossa, local pain, upper limb embolism, Horner's syndrome and hoarseness. Aneurysms were located on the right in 17 cases, on the left in 3 cases and on both sides in 2 cases. Fifteen (68%) patients underwent an intervention, of which 11 (50%) underwent an open surgical repair, and 4 (18%) underwent endovascular repair. The mean diameter of the aneurysms was 39.5 ± 20.7 mm in the open surgery group, and 24.0 ± 4.7 mm in the endovascular group. The follow-up duration ranged from 2 months to 12 years. One patient died of cardiogenic disease in the untreated group. Patients undergoing open operative repair had 100% patency of the reconstruction. In the endovascular group, one patient had stent occlusion 2 years after the operation. CONCLUSIONS The most common cause of isolated subclavian aneurysm without aberrant subclavian artery or coarctation of descending aorta is atherosclerosis. The clinical symptoms of aneurysms are varied, and the aneurysms tend to occur on the right side. Based on the anatomical conditions of SAAs, open surgery and endovascular repair can be used for treatment.
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Affiliation(s)
- Jing Sun
- Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Hongxia Qi
- Department of Ultrasound, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yi Shi
- Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Hongwei Guo
- Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Chenyang Shen
- Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Chenxi Ouyang
- Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xiangyang Qian
- Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
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Parlapiano G, Di Lorenzo F, Salehi LB, Ruvolo G, Novelli G, Sangiuolo F. Neurovascular manifestations in connective tissue diseases: The case of Marfan Syndrome. Mech Ageing Dev 2020; 191:111346. [DOI: 10.1016/j.mad.2020.111346] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/30/2020] [Accepted: 08/25/2020] [Indexed: 12/14/2022]
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Ghonem ME, Yuan X, Mitsis A, Nienaber CA. Interventional repair of a vascular aneurysm in a patient with Marfan syndrome. SAGE Open Med Case Rep 2018; 6:2050313X18788448. [PMID: 30046448 PMCID: PMC6056777 DOI: 10.1177/2050313x18788448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 06/11/2018] [Indexed: 11/16/2022] Open
Abstract
Marfan syndrome is a heritable connective tissue disorder affecting skeletal, ocular and cardiovascular systems. Cardiovascular manifestations comprise aneurysmal dilatation of aortic root, aortic dissection and rupture; peripheral arterial aneurysms have been reported in femoral, iliac and subclavian arteries with surgical reconstruction as the first-line therapeutic option. We report a Marfan patient with a symptomatic aneurysm of left subclavian artery in the intrathoracic retro-clavicular space; instead of open surgical resection, an endovascular solution was successfully applied by use of a flexible self-expanding stent-graft (W.L Gore® Viabahn® Endoprosthesis 9 × 100 mm) to exclude the aneurysm. This case exemplifies a modern option to manage vascular pathology even in patients with Marfan syndrome. Follow-up over 1 year proved very reassuring with complete remodelling and resolution of the aneurysm; long-term follow-up is certainly warranted, considering the potential of recurrence or initial reactive hyperplasia.
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Affiliation(s)
- Mohammed E Ghonem
- Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Trust and Imperial College, London, UK
| | - Xun Yuan
- Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Trust and Imperial College, London, UK
| | - Andreas Mitsis
- Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Trust and Imperial College, London, UK
| | - Christoph A Nienaber
- Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Trust and Imperial College, London, UK
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Yuan X, Mitsis A, Nienaber CA. Novel reconstruction of a vascular aneurysm in Marfan syndrome. J Vis Surg 2018; 4:67. [PMID: 29780713 DOI: 10.21037/jovs.2018.03.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/12/2018] [Indexed: 01/16/2023]
Affiliation(s)
- Xun Yuan
- Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Trust and Imperial College, London, UK
| | - Andreas Mitsis
- Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Trust and Imperial College, London, UK
| | - Christoph A Nienaber
- Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Trust and Imperial College, London, UK
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Li L, Zhang J, Wang R, Li J, Gu Y, Yu H. Endovascular Repair of a Right Subclavian Artery Aneurysm with Coil Embolization and Stent Graft: Case Report and Literature Review. Ann Vasc Surg 2016; 36:290.e1-290.e5. [DOI: 10.1016/j.avsg.2016.02.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/19/2016] [Accepted: 02/25/2016] [Indexed: 10/21/2022]
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Li L, Yu H, Qi Y, Qi L, Li J, Gu Y, Zhang J. Simultaneous Kissing Stent Technique with Stent Grafts for Subclavian Artery Aneurysm: A Case Report. Ann Vasc Surg 2015; 29:1316.e17-9. [DOI: 10.1016/j.avsg.2015.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 02/04/2015] [Accepted: 02/08/2015] [Indexed: 11/29/2022]
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Morimoto K, Matsuda H, Fukuda T, Iba H, Tanaka H, Sasaki H, Minatoya K, Kobayashi J. Hybrid Repair of Proximal Subclavian Artery Aneurysm. Ann Vasc Dis 2015; 8:87-92. [PMID: 26131027 DOI: 10.3400/avd.oa.15-00006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 03/25/2015] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Conventional open repair for proximal subclavian artery aneurysms (SCAAs) requires cardiopulmonary bypass. However, patients with proximal SCAA can be treated with hybrid repair. METHODS Between 2007 and 2012, we performed hybrid repair to treat six consecutive patients with proximal SCAA (three left SCAAs, one right aberrant SCAA, two right SCAAs). Their median age was 73.5 [70-87] years, and the size of their aneurysm was 33.5 [30-45] mm. Thoracic endovascular aneurysm repair (TEVAR) only was used for one patient with left SCAA, TEVAR and supra-aortic bypass for two with left SCAA and one with right aberrant SCAA, and endovascular repair with reconstruction of the vertebral artery using the saphenous vein graft (SVG) for two with right SCAA. RESULTS The follow-up duration was 3.7 [0.2-6.8] years. There was no 30-day mortality and only one early complication consisting of a minor stroke after TEVAR for shaggy aorta. Two late deaths occurred, one caused by cerebral infarction due to occlusion of SVG to the dominant vertebral artery 2 months after the operation and the other by aortic dissection 5 years postoperatively. CONCLUSIONS Hybrid repair can be a less-invasive alternative for proximal SCAA. Revascularization of neck vessels and TEVAR should be performed very carefully to prevent neurologic complications.
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Affiliation(s)
- Kazuki Morimoto
- Departments of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hitoshi Matsuda
- Departments of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tetsuya Fukuda
- Departments of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hiroshi Iba
- Departments of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hiroshi Tanaka
- Departments of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hiroaki Sasaki
- Departments of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kenji Minatoya
- Departments of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Junjiro Kobayashi
- Departments of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Zehm S, Chemelli A, Jaschke W, Fraedrich G, Rantner B. Long-term outcome after surgical and endovascular management of true and false subclavian artery aneurysms. Vascular 2014; 22:161-6. [PMID: 23493279 DOI: 10.1177/1708538113479514] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Subclavian artery aneurysm is a rare but serious disease due to the risk of thrombosis, embolization, rupture and compression of adjacent structures. Treatment consists of surgical and endovascular techniques. Up to now few long-term follow-up results have been reported. In our study the results from 15 patients treated for subclavian artery aneurysms were evaluated. Eleven patients underwent open surgical reconstruction, four patients were treated endovascularly. After a mean follow-up period of 77 months (83 months for the open surgical group, 38 months for the endovascular group), 10 of 11 open surgical reconstructions and all primarily implanted stent grafts were patent. Secondary intervention was necessary in two patients. Thirty-day mortality for both treatment groups was 0%. Subclavian artery aneurysm-related symptoms disappeared in six out of 10 patients after the treatment. Long-term outcomes with good technical results, patency rates and low periprocedural morbidity could be shown in both treatment groups.
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Kim SS, Jeong MH, Kim JE, Yim YR, Park HJ, Lee SH, Rhew SH, Jeong YW, Kim JH, Cho JG, Park JC. Successful treatment of a ruptured subclavian artery aneurysm presenting as hemoptysis with a covered stent. Chonnam Med J 2014; 50:70-3. [PMID: 25229020 PMCID: PMC4161765 DOI: 10.4068/cmj.2014.50.2.70] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 03/19/2014] [Accepted: 03/25/2014] [Indexed: 12/01/2022] Open
Abstract
An aneurysm of the subclavian artery is rare. Recently, we experienced a case of a ruptured subclavian artery aneurysm presenting as hemoptysis. The patient had experienced atypical chest discomfort, and computed tomography (CT) revealed a small aneurysm of the left subclavian artery (SCA). Hemoptysis occurred 2 weeks later. Follow-up CT showed a ruptured aneurysm at the proximal left SCA. Endovascular treatment with a graft stent was performed by bilateral arterial access with a 12-Fr introducer sheath placed via cutdown of the left axillary artery and an 8-Fr sheath in the right femoral artery. A self-expandable Viabahn covered stent measuring 13×5 mm was introduced retrogradely via the left axillary sheath and was positioned under contrast guidance with an 8-Fr JR4 guide through the femoral sheath. After the procedure, hemoptysis was not found, and the 3-month follow-up CT showed luminal patency of the left proximal SCA and considerable reduction of the hematoma.
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Affiliation(s)
- Sung Soo Kim
- The Heart Center of Chonnam National University Hospital, Cardiovascular Research Institute of Chonnam National University, Gwangju, Korea
| | - Myung Ho Jeong
- The Heart Center of Chonnam National University Hospital, Cardiovascular Research Institute of Chonnam National University, Gwangju, Korea
| | - Ji Eun Kim
- The Heart Center of Chonnam National University Hospital, Cardiovascular Research Institute of Chonnam National University, Gwangju, Korea
| | - Yi Rang Yim
- The Heart Center of Chonnam National University Hospital, Cardiovascular Research Institute of Chonnam National University, Gwangju, Korea
| | - Hyuk Jin Park
- The Heart Center of Chonnam National University Hospital, Cardiovascular Research Institute of Chonnam National University, Gwangju, Korea
| | - Seung Hun Lee
- The Heart Center of Chonnam National University Hospital, Cardiovascular Research Institute of Chonnam National University, Gwangju, Korea
| | - Shi Hyun Rhew
- The Heart Center of Chonnam National University Hospital, Cardiovascular Research Institute of Chonnam National University, Gwangju, Korea
| | - Young Wook Jeong
- The Heart Center of Chonnam National University Hospital, Cardiovascular Research Institute of Chonnam National University, Gwangju, Korea
| | - Ju Han Kim
- The Heart Center of Chonnam National University Hospital, Cardiovascular Research Institute of Chonnam National University, Gwangju, Korea
| | - Jeong Gwan Cho
- The Heart Center of Chonnam National University Hospital, Cardiovascular Research Institute of Chonnam National University, Gwangju, Korea
| | - Jong Chun Park
- The Heart Center of Chonnam National University Hospital, Cardiovascular Research Institute of Chonnam National University, Gwangju, Korea
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He C, Wu X, Cao J, Fan X, Liu K, Liu B. Endovascular management of spontaneous axillary artery aneurysm: a case report and review of the literature. J Med Case Rep 2013; 7:140. [PMID: 23714201 PMCID: PMC3673813 DOI: 10.1186/1752-1947-7-140] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 04/05/2013] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Spontaneous atraumatic true axillary artery aneurysm is a relatively unusual disorder. Although most cases are asymptomatic, complications of axillary artery aneurysms may result in acute vascular insufficiency and neurological deficits. Prompt treatment, therefore, should be employed in the management of this condition. To date, the standard treatment for peripheral aneurysms is still surgical resection with end-to-end anastomosis. However, aneurysmectomy and interposition grafting with autologous or artificial vessels are more invasive and time-consuming. The ideal treatment for axillary artery aneurysm should be relatively noninvasive, safe and free of significant complications, cost-effective, cosmetically acceptable, and incur less absence from usual daily activities. Endovascular stent grafts have also been successfully used to treat these aneurysms. Management of select aneurysms using stent grafts has become more prevalent with the developing endoluminal technology. CASE PRESENTATION We report a case of a spontaneous atraumatic axillary artery aneurysm where the patient was a 48-year-old ethnic Han Chinese woman with a gradually enlarging left axillary pulsatile mass. She was treated with endovascular stent grafts. The postoperative course of the patient was uneventful during the six-month follow-up. CONCLUSIONS We show that there are significant early advantages with the endovascular management technique versus the conventional operation in the management of axillary artery aneurysm.
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Affiliation(s)
- Changsheng He
- Institute of General Surgery, Nanjing Jinling Hospital, 305 East Zhongshan Road, Nanjing 210002, China.
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Matsuno Y, Ishida N, Shimabukuro K, Takemura H. An unusual case of the right subclavian artery aneurysm resulting from long-term repetitive blunt chest trauma. J Vasc Surg 2012; 56:219-22. [PMID: 22480763 DOI: 10.1016/j.jvs.2012.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 01/06/2012] [Accepted: 01/07/2012] [Indexed: 11/29/2022]
Abstract
This case report describes a right subclavian artery aneurysm secondary to long-term repetitive blunt trauma. A 62-year-old man with a right subclavian artery aneurysm had had a history of bird hunting using a shotgun that impacted substantially against his right clavicula and shoulder weekly for >20 years. The patient underwent open repair with partial sternotomy and distal balloon control. The aneurysmal sac was resected, and the right subclavian artery was reconstructed with a primary end-to-end anastomosis. Histopathologic examination of the resected aneurysmal wall revealed that all three layers of the arterial wall were comparatively intact, with fibrosis and lipid deposition in the intima and in various degrees of degeneration in the media, suggesting a true aneurysm.
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Affiliation(s)
- Yukihiro Matsuno
- Department of Advanced Surgery, Division of Organ Pathobiology, Gifu University School of Medicine, Gifu, Japan.
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Roh YN, Park KB, Do YS, Kim WS, Kim YW, Kim DI. A hybrid operation in a patient with complex right subclavian artery aneurysm. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 82:195-9. [PMID: 22403755 PMCID: PMC3294115 DOI: 10.4174/jkss.2012.82.3.195] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 09/16/2011] [Accepted: 10/05/2011] [Indexed: 11/30/2022]
Abstract
We report a hybrid surgery including endovascular aneurysm repair and debranching procedures to treat a patient with a complex right subclavian artery aneurysm. The patient was a 70-year-old woman who presented with dry cough and hoarseness. The aneurysm was characterized by the absence of a proximal neck, and involvement of the origin of the right vertebral artery. She underwent carotid-vertebral artery bypass, stent graft from the innomiate artery to the common carotid artery and carotid-axillary artery bypass. Great saphenous vein was used for the carotid-vertebral artery bypass and 7 mm reinforced polytetrafluoroethylene graft was used for the carotid-axillary artery bypass. The postoperative course was uneventful.
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Affiliation(s)
- Young-Nam Roh
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Endovascular treatment of ruptured axillary and large internal mammary artery aneurysms in a patient with Marfan syndrome. J Vasc Surg 2010; 53:478-82. [PMID: 21050698 DOI: 10.1016/j.jvs.2010.08.076] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 08/18/2010] [Accepted: 08/25/2010] [Indexed: 11/23/2022]
Abstract
Marfan syndrome is an autosomally inherited disorder affecting the synthesis of connective tissues. Vascular manifestations of Marfan syndrome include aneurysmal dilatation of the aortic root, aortic dissection, and rupture. Peripheral aneurysms are mostly reported in the iliac, femoral, and subclavian arteries. We report a Marfan patient with a ruptured axillary artery aneurysm and a large left internal mammary artery aneurysm. The axillary aneurysm was successfully excluded using covered stent grafts, and the left internal mammary artery aneurysm was effectively coiled. Duplex ultrasound imaging at 4 months and computed tomography at 9 months demonstrated complete thrombosis and exclusion of both aneurysms with patent subclavian-axillary stent grafts.
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Vierhout B, Zeebregts C, van den Dungen J, Reijnen M. Changing Profiles of Diagnostic and Treatment Options in Subclavian Artery Aneurysms. Eur J Vasc Endovasc Surg 2010; 40:27-34. [DOI: 10.1016/j.ejvs.2010.03.011] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 03/09/2010] [Indexed: 11/24/2022]
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Bowman JN, Ellozy SH, Plestis K, Marin ML, Faries PL. Hybrid Repair of Bilateral Subclavian Artery Aneurysms in a Patient with Marfan Syndrome. Ann Vasc Surg 2010; 24:114.e1-5. [DOI: 10.1016/j.avsg.2009.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 03/31/2009] [Accepted: 04/13/2009] [Indexed: 10/20/2022]
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Sacchi ADA, Medeiros AZD, Ribeiro Filho R. Tratamento endovascular híbrido de aneurisma da artéria subclávia associado à síndrome de Marfan: relato de caso. J Vasc Bras 2008. [DOI: 10.1590/s1677-54492008000200008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Descreve-se o caso de uma paciente feminina de 46 anos com síndrome de Marfan que foi diagnosticada com aneurisma da artéria subclávia direita após cirurgia aberta para reparo de dissecção aórtica tipo A. A paciente foi tratada por abordagem híbrida, que combinou o implante de uma endoprótese recoberta da artéria inominada para a carótida comum direita com uma ponte carótida para a artéria axilar direita. O pós-operatório transcorreu sem complicações, com a confirmação, por ultra-som, do sucesso da exclusão do aneurisma.
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Geisbüsch P, Kotelis D, von Tengg-Kobligk H, Hyhlik-Dürr A, Allenberg JR, Böckler D. Thoracic Aortic Endografting in Patients With Connective Tissue Diseases. J Endovasc Ther 2008; 15:144-9. [DOI: 10.1583/07-2286.1] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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du Toit DF, Lambrechts AV, Stark H, Warren BL. Long-term results of stent graft treatment of subclavian artery injuries: management of choice for stable patients? J Vasc Surg 2008; 47:739-43. [PMID: 18242938 DOI: 10.1016/j.jvs.2007.11.009] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Revised: 11/08/2007] [Accepted: 11/08/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND The management of penetrating subclavian artery injuries poses a formidable surgical challenge. The feasibility of stent graft repair is already established. General use of this modality is not widely accepted due to concerns regarding the long-term outcome in a generally young patient population. We review our stent graft experience to examine long-term outcomes. METHODS All patients with penetrating subclavian artery injuries were evaluated for stent graft repair. Patients were excluded when hemodynamically unstable or unsuitable on other clinical and angiographic grounds. Patients were followed prospectively for early (<30 days) and late (>30 days) complications. Clinical and telephone evaluation, Doppler pressures, duplex Doppler, and angiography (when indicated), were used to asses patients at follow-up. Outcomes were recorded as technical success of procedure, graft patency, arm claudication, limb loss, the need for open surgical repair, the presence or absence of other complications, and death. RESULTS Fifty-seven patients underwent stent graft treatment during the 10-year period. Mean age was 34, and 91% were men. There were 53 stab wounds and four gunshot injuries. Pathology included false aneurysms (n = 42), arteriovenous fistula (n = 12), and three arterial occlusions. Early complications: One patient (2%) had a femoral puncture site injury which was managed with open surgical repair. One patient died early due to multiple organ failure related to concomitant injuries. Three patients (5%) presented with graft occlusion and nonlimb threatening ischemia in the first week after treatment. All three patients were managed successfully with a second endovascular intervention. Late complications: Twenty-five (44%) of the 57 patients with subclavian artery injuries were followed-up with a mean duration of 48 months. Two patients died as a result of fatal stab wounds months after their first injuries. Five patients (20%) and three patients (12%) presented with angiographically significant stenosis and occlusions, respectively. The stenotic lesions were successfully managed with endovascular intervention, and the occluded lesions were managed conservatively. No patient experienced life or limb loss or any incapacitating symptoms at the end of the study period. There was no need for conversion to open surgery. CONCLUSIONS This study has reaffirmed the feasibility and safety of stent graft repair in treating stable patients with selected penetrating subclavian artery injuries. The results of this study also confirmed acceptable long-term follow-up without any limb or life threatening complications. We conclude that endovascular repair should be considered the first choice of treatment in stable patients with subclavian artery injuries.
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Affiliation(s)
- Daniel F du Toit
- Department of Surgery, University of Stellenbosch, Tygerberg Hospital, Tygerberg, South Africa.
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González JMD, García BA, Lebrun JM, Docampo MM. Combined surgery for the treatment of bilateral subclavian artery aneurysm in Marfan syndrome. J Vasc Surg 2007; 45:180-2. [PMID: 17210405 DOI: 10.1016/j.jvs.2006.08.045] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2006] [Accepted: 08/14/2006] [Indexed: 11/26/2022]
Abstract
Large bilateral aneurysm of the subclavian artery is an infrequent entity that can progress to thrombosis, embolization, or rupture if left untreated. Treatment consists of exclusion of the aneurysm by an endovascular procedure or open surgery. We present a case of large bilateral subclavian artery aneurysm in a patient with Marfan syndrome that was treated by a combination of endovascular and conventional surgery. This therapeutic approach provided good results for patency with lower morbidity and mortality.
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Tassiopoulos AK, Nadalin BA, Labropoulos N, Egofske P, Keen RR. Endovascular repair of a symptomatic subclavian artery aneurysm in a patient with Marfan syndrome: a case report. Vasc Endovascular Surg 2006; 40:409-13. [PMID: 17038575 DOI: 10.1177/1538574406293764] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Endovascular techniques are being employed with increasing frequency in the management of peripheral arterial aneurysms. A 57-year-old patient with Marfan syndrome presented with a symptomatic 5 cm left subclavian artery aneurysm. He underwent successful endovascular exclusion of the aneurysm with immediate improvement of his symptoms. Duplex ultrasound 3 months after the procedure confirmed a patent graft and complete exclusion of the aneurysm.
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Affiliation(s)
- Apostolos K Tassiopoulos
- Department of Surgery, Division of Vascular Surgery, The John H. Stroger, Jr, Hospital of Cook County, Chicago, USA.
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Resch TA, Lyden SP, Gavin TJ, Clair DG. Combined open and endovascular treatment of a right subclavian artery aneurysm: A case report. J Vasc Surg 2005; 42:1206-9. [PMID: 16376215 DOI: 10.1016/j.jvs.2005.07.045] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2005] [Accepted: 07/25/2005] [Indexed: 12/01/2022]
Abstract
A 69-year-old man with previous ascending aortic repair combined with valve replacement for an ascending aortic aneurysm presented with a type 2 thoracoabdominal aneurysm and a 4.4-cm aneurysm of the right subclavian artery. Because of the anatomic location of the aneurysm and his previous operation, an innominate to carotid artery stent graft and a carotid-subclavian bypass and vertebral artery bypass were performed. Postoperative computed tomographic angiography confirmed good flow in the right carotid and vertebral artery, and the patient recovered without complication.
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Affiliation(s)
- Timothy A Resch
- Department of Vascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Bin HG, Kim MS, Kim SC, Keun JB, Lee JH, Kim SS. Intrathoracic aneurysm of the right subclavian artery presenting with hoarseness: a case report. J Korean Med Sci 2005; 20:674-6. [PMID: 16100464 PMCID: PMC2782168 DOI: 10.3346/jkms.2005.20.4.674] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Intrathoracic segment of the subclavian artery is an unusual location for peripheral arterial aneurysms. They are normally caused by atherosclerosis, medial degeneration, trauma, and infection. We report a case of a patient with right subclavian artery aneurysm presenting with hoarseness. Chest radiograph demonstrated a superior mediastinal mass. Laryngoscopy showed a fixed right vocal cord. By chest computed tomography, magnetic resonance imaging, and angiography, preoperative diagnosis was established as a saccular aneurysm with afferent loop and efferent loop. Patient underwent complete resection of the aneurysm followed by endto-end anastomosis via median sternotomy. Postoperative pathology was consistent with an atherosclerotic aneurysm filled with thrombus. After surgical operation, hoarseness is still continued.
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Affiliation(s)
- Hong Gun Bin
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myoung Sook Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok Chan Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Bum Keun
- Department of Thoracic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Ho Lee
- Department of Thoracic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Soo Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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