1
|
Sormaz IC, Iscan AY, Tunca F, Kostek M, Aygun N, Matlim Ozel T, Soytas Y, Poyanli A, Sari S, Uludag M, Giles Senyurek Y. Electrophysiological monitoring of the nonrecurrent inferior laryngeal nerve and radiological evaluation of concurrent vascular anomalies. Front Endocrinol (Lausanne) 2024; 15:1420697. [PMID: 39371923 PMCID: PMC11449809 DOI: 10.3389/fendo.2024.1420697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 09/03/2024] [Indexed: 10/08/2024] Open
Abstract
Purpose The objective of this study was to characterize the electrophysiological characteristics of nonrecurrent inferior laryngeal nerves (NRILNs) that were dissected via intraoperative neuromonitoring (IONM) and concomitant vascular anomalies in patients with NRILNs. Methods A retrospective analysis was conducted on 7865 patients who underwent thyroidectomy with IONM at three tertiary referral centers. The study included 42 patients in whom an NRILN was detected. IONM data and postoperative vocal cord (VC) examinations were recorded for all patients. The absence of an initial vagal EMG response and/or a short (<3.5 ms) latency period during the initial vagal stimulation or the inability to identify the RLN within the Beahrs triangle was considered highly suspicious for the presence of an NRILN. Postoperative cross-sectional imaging was performed in 36 out of 42 patients to assess any concurrent vascular anomalies. Results The prevalence of NRILN was 0.53%. An NRILN was suspected due to EMG findings in 32 (76%) patients and the inability to identify the RLN within the Beahrs triangle in the remaining 10 (24%) patients. The mean right VN latency period was 3.05 ± 0.15 ms. The V1 latency period of the right VN was shorter than 3.5 ms in 39 (93%) and longer than 3.5 ms in 3 (7%) patients. One of these three patients with latency>3.5ms had a large mediastinal goiter. Transient VC paralysis occurred in one (2.4%) patient. Of the 36 patients with postoperative imaging data, 33 (91.4%) had vascular anomalies. All 33 patients had aberrant right subclavian arteries, and 13 (39.4%) also had accompanying additional vascular anomalies. Conclusion The NRILN is an anatomical variation that increases the risk of nerve injury. Observation of an absent EMG response and/or a short latency period during the initial vagal stimulation facilitates the detection of an NRILN at an early stage of thyroidectomy in the majority of patients.
Collapse
Affiliation(s)
- Ismail Cem Sormaz
- Division of Endocrine Surgery, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Ahmet Yalin Iscan
- Division of Endocrine Surgery, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Fatih Tunca
- Division of Endocrine Surgery, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Mehmet Kostek
- Division of Endocrine Surgery, Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Türkiye
| | - Nurcihan Aygun
- Division of Endocrine Surgery, Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Türkiye
| | - Tugba Matlim Ozel
- Division of Endocrine Surgery, Department of General Surgery, Basaksehir Cam and Sakura City Hospital, University of Health Sciences Turkey, Istanbul, Türkiye
| | - Yigit Soytas
- Division of Endocrine Surgery, Department of General Surgery, Basaksehir Cam and Sakura City Hospital, University of Health Sciences Turkey, Istanbul, Türkiye
| | - Arzu Poyanli
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Serkan Sari
- Division of Endocrine Surgery, Department of General Surgery, Basaksehir Cam and Sakura City Hospital, University of Health Sciences Turkey, Istanbul, Türkiye
| | - Mehmet Uludag
- Division of Endocrine Surgery, Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Türkiye
| | - Yasemin Giles Senyurek
- Division of Endocrine Surgery, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| |
Collapse
|
2
|
Chen J, Liu L, Kou X, Wang C. Case report: Right vertebral and carotid artery anomalies with an aberrant right subclavian artery in two patients. Front Neurol 2023; 14:1282127. [PMID: 38152639 PMCID: PMC10751957 DOI: 10.3389/fneur.2023.1282127] [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: 08/23/2023] [Accepted: 11/28/2023] [Indexed: 12/29/2023] Open
Abstract
Abnormal origins of the vertebral artery with supra-aortic vessel variants are exceedingly uncommon. Herein, we present two cases of the vertebral artery originating from the right common carotid artery associated with the right subclavian artery arising separately as the initial branch of the aortic arch, followed by the right common carotid artery. We reviewed the embryology of the anomalous origins of the vertebral and subclavian arteries. These variants can significantly affect surgical planning and cause severe clinical symptoms.
Collapse
Affiliation(s)
- Jiang Chen
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
- Department of Neurosurgery, Dazhu Hospital, Dazhou, China
| | - LunXin Liu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaobo Kou
- Department of Neurosurgery, The First People’s Hospital in Shuangliu District/West China Airport Hospital, Sichuan University, Chengdu, China
| | - Chaohua Wang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| |
Collapse
|
3
|
Schweighofer N, Dolinšek J, Rupreht M. Arteria Lusoria as a Cause of Dysphagia in an Infant. J Pediatr Health Care 2023; 37:702-705. [PMID: 37516943 DOI: 10.1016/j.pedhc.2023.07.001] [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: 03/16/2023] [Revised: 06/05/2023] [Accepted: 07/11/2023] [Indexed: 07/31/2023]
Abstract
The aberrant right subclavian artery (i.e., arteria lusoria) arising from the left part of the aortic arch is a rare congenital anomaly. In some patients, esophageal compression may cause symptoms of dysphagia, also called dysphagia lusoria. It can cause serious feeding disorders and poor weight gain in young children. We present the case of an early onset of dysphagia lusoria in a 1-month-old girl whose clinical diagnosis was confirmed by esophagography and magnetic resonance imaging. This kind of vascular anomaly can present a diagnostic challenge and should be considered in diagnosing dysphagia in childhood.
Collapse
|
4
|
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.
Collapse
Affiliation(s)
| | - Punnapa Raviteja
- Department of Anatomy, AIIMS Bibinagar, Hyderabad, 508126, India
| | - Rohini Motwani
- Department of Anatomy, AIIMS Bibinagar, Hyderabad, 508126, India.
| |
Collapse
|
5
|
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]
|
6
|
Karaman A, Araz Ö, Ay M, Ucar EY. Dissection of the aberrant right subclavian artery: a very rare finding. Br J Hosp Med (Lond) 2021; 82:1. [PMID: 34601939 DOI: 10.12968/hmed.2021.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Adem Karaman
- Department of Radiology, Ataturk University School of Medicine, Erzurum, Turkey
| | - Ömer Araz
- Department of Pulmonary Diseases, Ataturk University School of Medicine, Erzurum, Turkey
| | - Mutlu Ay
- Department of Radiology, Ataturk University School of Medicine, Erzurum, Turkey
| | - Elif Y Ucar
- Department of Radiology, Ataturk University School of Medicine, Erzurum, Turkey
| |
Collapse
|
7
|
Vitošević F, Vitošević Z, Rasulić L. The right vertebral artery arising from the right common carotid artery: report of a rare case. Surg Radiol Anat 2020; 42:1263-1266. [PMID: 32519040 DOI: 10.1007/s00276-020-02514-7] [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] [Received: 01/23/2020] [Accepted: 06/03/2020] [Indexed: 10/24/2022]
Abstract
Anomalous origins of the vertebral arteries are uncommon and generally associated with other abnormalities of the supra-aortic vessels. We present an extremely rare case where the right vertebral artery is arising from the right common carotid artery, with an absent brachiocephalic trunk, and the right common carotid artery as the first branch of the aortic arch followed by right subclavian artery, without any other abnormalities of the supra-aortic vessels. This vessel variation can affect endovascular procedures, surgical interventions and cause some unexpected clinical symptoms.
Collapse
Affiliation(s)
- Filip Vitošević
- Neuroradiology Department, Center for Radiology and MRI, Clinical Center of Serbia, Belgrade, Serbia
| | - Zdravko Vitošević
- Faculty of Medicine, University of Pristina, Kosovska Mitrovica, Serbia
| | - Lukas Rasulić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia. .,Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia.
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Abstract
UNLABELLED PurposeThe aim of the study was to perform CT angiography-based evaluation of aberrant right subclavian artery prevalence, anatomy, and its influence on clinical symptoms. METHODS A total of 6833 patients who underwent 64-slice or dual-source CT angiography and those who revealed aberrant right subclavian artery underwent evaluation of its anatomy and were interviewed for the presence of clinical symptoms. RESULTS Aberrant right subclavian artery was found in 32 (0.47%) patients consisting of 13 males and 19 females, with mean age of 60.8±13.4 years. Among the interviewed 30 (94%) patients, oesophageal compression was observed in 14 cases (47%) and tracheal compression in three cases (10%). None of the patients underwent surgery related to aberrant right subclavian artery. Dysphagia was the most common clinical symptom in nine cases (30%), and in those patients the median distance between aberrant right subclavian artery and trachea was lower (4 mm) than in individuals without dysphagia (7.5 mm) (p = 0.009). The median lumen area of the aberrant right subclavian artery at the level of oesophagus was higher in patients with dysphagia (208 mm2) compared with individuals without dysphagia (108 mm2) (p = 0.01). CONCLUSIONS Aberrant right subclavian artery is a rare occurring abnormality in CT angiography. In the evaluated adult population, the most common symptom was dysphagia, which occurred in patients with decreased distance between aberrant right subclavian artery and trachea and increased lumen area of the aberrant artery at the level of compressed oesophagus.
Collapse
|
10
|
Ratnayake CBB, Escott ABJ, Phillips ARJ, Windsor JA. The anatomy and physiology of the terminal thoracic duct and ostial valve in health and disease: potential implications for intervention. J Anat 2018; 233:1-14. [PMID: 29635686 DOI: 10.1111/joa.12811] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2018] [Indexed: 12/31/2022] Open
Abstract
The thoracic duct (TD) transports lymph drained from the body to the venous system in the neck via the lymphovenous junction. There has been increased interest in the TD lymph (including gut lymph) because of its putative role in the promotion of systemic inflammation and organ dysfunction during acute and critical illness. Minimally invasive TD cannulation has recently been described as a potential method to access TD lymph for investigation. However, marked anatomical variability exists in the terminal segment and the physiology regarding the ostial valve and terminal TD is poorly understood. A systematic review was conducted using three databases from 1909 until May 2017. Human and animal studies were included and data from surgical, radiological and cadaveric studies were retrieved. Sixty-three articles from the last 108 years were included in the analysis. The terminal TD exists as a single duct in its terminal course in 72% of cases and 13% have multiple terminations: double (8.5%), triple (1.8%) and quadruple (2.2%). The ostial valve functions to regulate flow in relation to the respiratory cycle. The patency of this valve found at the lymphovenous junction opening, is determined by venous wall tension. During inspiration, central venous pressure (CVP) falls and the valve cusps collapse to allow antegrade flow of lymph into the vein. During early expiration when CVP and venous wall tension rises, the ostial valve leaflets cover the opening of the lymphovenous junction preventing antegrade lymph flow. During chronic disease states associated with an elevated mean CVP (e.g. in heart failure or cirrhosis), there is a limitation of flow across the lymphovenous junction. Although lymph production is increased in both heart failure and cirrhosis, TD lymph outflow across the lymphovenous junction is unable to compensate for this increase. In conclusion the terminal TD shows marked anatomical variability and TD lymph flow is controlled at the ostial valve, which responds to changes in CVP. This information is relevant to techniques for cannulating the TD, with the aid of minimally invasive methods and high resolution ultrasonography, to enable longitudinal physiology and lymph composition studies in awake patients with both acute and chronic disease.
Collapse
Affiliation(s)
| | | | - Anthony Ronald John Phillips
- Department of Surgery, University of Auckland, Auckland, New Zealand.,Applied Surgery and Metabolism Laboratory, School of Biological Sciences, University of Auckland, New Zealand
| | | |
Collapse
|
11
|
Still GG, Li S, Wilson M, Wong L, Sammut P. Retrotracheal Aberrant Right Subclavian Artery: Congenital Anomaly or Postsurgical Complication? Glob Pediatr Health 2018; 5:2333794X18762689. [PMID: 29552601 PMCID: PMC5846904 DOI: 10.1177/2333794x18762689] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 02/05/2018] [Indexed: 01/03/2023] Open
Affiliation(s)
| | - Shuo Li
- Yale New Haven Health Bridgeport Hospital, Bridgeport, CT, USA
| | - Mark Wilson
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Lincoln Wong
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Paul Sammut
- University of Nebraska Medical Center, Omaha, NE, USA
| |
Collapse
|
12
|
Boysan E, Circi R. Reliability of axillary artery cannulation. Eur J Cardiothorac Surg 2017; 52:830. [PMID: 28605538 DOI: 10.1093/ejcts/ezx185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 05/10/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Emre Boysan
- Department of Cardiovascular Surgery, Liv Hospital, Ankara, Turkey
| | - Renda Circi
- Department of Cardiovascular Surgery, Liv Hospital, Ankara, Turkey
| |
Collapse
|
13
|
Successful video-assisted thoracoscopic surgery in prone position in patients with esophageal cancer and aberrant right subclavian artery: report of three cases. Surg Case Rep 2017; 3:86. [PMID: 28755160 PMCID: PMC5533695 DOI: 10.1186/s40792-017-0360-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 07/11/2017] [Indexed: 11/16/2022] Open
Abstract
Background An aberrant right subclavian artery (ARSA) with an associated nonrecurrent right inferior laryngeal nerve (NRILN) is a relatively rare anomaly that occurs at a frequency of 0.3 to 2.0% of the general population. NRILN has been mainly documented in the head and neck region; it has been rarely described in patients with esophageal cancer, especially those undergoing thoracoscopic surgery. Video-assisted thoracoscopic surgery for esophageal cancer (VATS-E) is becoming more widespread as a reliable minimally invasive surgical procedure associated with reduced perioperative complications. Case presentation Herein, we report three cases of esophageal cancer with ARSA and NRILN which underwent successful VATS-E. Case 1, a 53-year-old male who had early stage esophageal cancer was performed VATS-E. Upper gastrointestinal (GI) series showed “Bayonet sign” (T1aN0M0, pStageIA in UICC). Case 2, a 75-year-old male who had advanced esophageal cancer was performed neoadjuvant chemotherapy and following VATS-E. This case had right thoracic duct and “Bayonet sign” on upper GI series (T1bN2M0, pStage IIIA in UICC). Case3, a 72-year-old male who had advanced esophageal cancer was performed neoadjuvant chemotherapy and following VATS-E (T3N2M0, pStageIIIB in UICC). All of these three cases were performed VATS-E and discharged without any complication. Conclusion VATS-E in the prone position is a feasible procedure that can reduce the risk of complications with an enlarged and clear view, and knowledge of this type of anomaly is very important for surgeons who perform esophagectomy.
Collapse
|
14
|
Mazzaccaro D, Derosa TM, De Febis E, Righini P, Nano G. Total endovascular repair of aberrant right subclavian artery aneurysm using the periscope technique: a case report. Int J Surg Case Rep 2016; 29:126-129. [PMID: 27842259 PMCID: PMC5109263 DOI: 10.1016/j.ijscr.2016.10.067] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/30/2016] [Indexed: 11/17/2022] Open
Abstract
Aneurysmal aberrant right subclavian arteries (ARSA) have a high risk of rupture. Treatment options include open surgery or hybrid surgical and endovascular repair. The “periscope” technique allows the urgent endovascular repair of aneurysmal ARSA.
Introduction Aneurysmal degeneration of aberrant right subclavian artery (ARSA) carries a relevant risk of rupture. Timely elective treatment is mandatory. Therapeutic options include open surgery repair or hybrid surgical and endovascular repair. Few reports of total endovascular approach repair have been reported. Presentation of the case We report the first case of total endovascular repair of an aneurysmal ARSA using a thoracic aortic endograft with a “periscope” covered stent into the ARSA itself. Discussion The total endovascular approach was considered for patient’s age and her poor compliance to the idea of a surgical revascularization of the ARSA, which has to be preserved since the LSA was diseased. The urgent situation did not allow for the use of a custom-made graft, so the idea of a “periscope” covered graft both to preserve the flow of the ARSA and to exclude the aneurysmal lesion seemed to be the best choice. Conclusion The “periscope” technique allowed the urgent treatment of aneurysmal ARSA with good clinical results.
Collapse
Affiliation(s)
| | | | | | - Paolo Righini
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giovanni Nano
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; University of Milan, Milan, Italy
| |
Collapse
|
15
|
Song Y. Thoracic Duct, Cisterna Chyli, and Right Lymphatic Duct. BERGMAN'S COMPREHENSIVE ENCYCLOPEDIA OF HUMAN ANATOMIC VARIATION 2016:921-934. [DOI: 10.1002/9781118430309.ch75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
16
|
Menon RS, Muetterties C, Moser GW, Wheatley GH. Endoanchor stenting for the repair of a Type I endoleak in the aortic arch following the endovascular repair of a Kommerrell's diverticulum. J Card Surg 2016; 31:541-3. [DOI: 10.1111/jocs.12793] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Rohan S. Menon
- Howard University, College of Medicine; Washington District of Columbia
| | - Corbin Muetterties
- Division of Cardiovascular Surgery; Temple University School of Medicine; Philadelphia Pennsylvania
| | - George William Moser
- Division of Cardiovascular Surgery; Temple University School of Medicine; Philadelphia Pennsylvania
| | - Grayson H. Wheatley
- Division of Cardiovascular Surgery; Temple University School of Medicine; Philadelphia Pennsylvania
| |
Collapse
|
17
|
Maiti TK, Konar SK, Bir S, Nanda A, Cuellar H. Anomalous Origin of the Right Vertebral Artery: Incidence and Significance. World Neurosurg 2016; 89:601-10. [PMID: 26897702 DOI: 10.1016/j.wneu.2015.11.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 11/06/2015] [Accepted: 11/07/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Detailed knowledge about anatomic variations of the aortic arch and its multiple branches is extremely important to endovascular and diagnostic radiologists. It is often hypothesized that anomalous origin and distribution of large aortic vessels may alter the cerebral hemodynamics and potentially lead to a vascular pathology. METHODS In this article, we describe a case of anomalous origin of the right vertebral artery, which was detected during an intervention. We further reviewed the available literature of anomalous origin of the right vertebral artery. The probable embryologic development and clinical significance are discussed. RESULTS The incidence of anomalous origin of a vertebral artery seems to be underestimated in recent literature. A careful review of the literature shows more than 100 such cases. The right vertebral artery can arise from the aortic arch or one of its branches. Dual origin of the vertebral artery is not uncommon. The embryologic developmental hypotheses are contradictory and complex. CONCLUSIONS Anomalous origin of the right vertebral artery may not be the sole reason behind a disease process. However, it can certainly lead to a misdiagnosis during diagnostic vascular studies. Detailed information is essential for any surgery or endovascular intervention in this location.
Collapse
Affiliation(s)
- Tanmoy Kumar Maiti
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Subhas Kanti Konar
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Shyamal Bir
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Anil Nanda
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Hugo Cuellar
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
| |
Collapse
|
18
|
Abstract
An aberrant right subclavian artery arising from a left aortic arch is the most frequently described congenital aortic arch anomaly, occurring in 0.5 to 2.3% of the general population. Despite the retro-oesophageal course of the aberrant subclavian artery, an arterio-oesophageal fistula is an uncommon finding, only previously reported as a very rare complication in critically ill patients with oesophageal instrumentation or foreign body ingestion. We describe a unique case of a spontaneous aberrant right subclavian arterio-oesophageal fistula without an inciting event in a 17-month-child.
Collapse
|
19
|
Darwazah AK, Eida M, Khalil RA, Ismail H, Hanbali N. Non-aneurysmal aberrant right subclavian artery causing dysphagia in a young girl: challenges encountered using supraclavicular approach. J Cardiothorac Surg 2015; 10:92. [PMID: 26143294 PMCID: PMC4491425 DOI: 10.1186/s13019-015-0303-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 06/23/2015] [Indexed: 11/27/2022] Open
Abstract
Aberrant right subclavian artery is the most common anomaly of the aortic arch. Patients are often asymptomatic and discovered accidentally. Occasionally, they present with symptoms related to oesophageal or tracheal compression. A 13-year-old girl presented with dysphagia and stridor was found to have an aberrant right subclavian artery. Surgical division and reconstruction of the artery was performed initially through right supraclavicular approach. An additional left thoracotomy was performed to overcome the challenges encountered at initial operation.
Collapse
Affiliation(s)
- Ahmad K Darwazah
- Department of Cardiac Surgery, Ramallah Hospital, Ramallah, Israel. .,Makassed Hospital, Mount of Olives, 91194, Jerusalem, Israel.
| | - Mohammed Eida
- Department of Cardiac Surgery, Ramallah Hospital, Ramallah, Israel.
| | - Ramzi Abu Khalil
- Department of Cardiac Surgery, Ramallah Hospital, Ramallah, Israel.
| | - Hassan Ismail
- Department of Cardiac Anesthesia, Ramallah Hospital, Ramallah, Israel.
| | - Naser Hanbali
- Department of Cardiac Anesthesia, Ramallah Hospital, Ramallah, Israel.
| |
Collapse
|
20
|
Kouki S, Fadhel A, Landoulsi M, Boujemaa H, Ben Abdallah N. Atlas tomodensitométriques des variations anatomiques des troncs supra-aortiques. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.frad.2014.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
21
|
de Araújo G, Junqueira Bizzi JW, Muller J, Cavazzola LT. "Dysphagia lusoria" - Right subclavian retroesophageal artery causing intermitent esophageal compression and eventual dysphagia - A case report and literature review. Int J Surg Case Rep 2015; 10:32-4. [PMID: 25797354 PMCID: PMC4429950 DOI: 10.1016/j.ijscr.2015.02.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 02/23/2015] [Accepted: 02/25/2015] [Indexed: 01/12/2023] Open
Abstract
Case report of a right subclavian retroesophageal artery (RSRA) found occasionaly on a chest CT. The malformation caused intermittent dysphagia. Patient presented with long history of upper digestive symptoms and gastroesophageal reflux disease.
We report a case of an uncommon anatomical anomaly in which a right subclavian retroesophageal artery (RSRA) was discovered during a routine chest CT scan in a patient with intermittent upper digestive symptoms (occasional dysphagia for solids, the so called “globus hystericus”). Subclavian arteries vary in their origin, course or length. RSRA is a relatively common embryological anomaly of the aortic arch. In this case we report a single carotid trunk. This variation is due to interruption of the fourth right aortic arch between the origins to the common carotid artery and subclavian artery, while the fourth left arch is intact. The regression of the proximal portion of the right subclavian artery occurs and the retroesophageal aortic arch persists, rarely leading to symptoms, as were present in this case.
Collapse
Affiliation(s)
- Guilherme de Araújo
- Departamento de Ciências Morfológicas, Instituto de Biociências, Universidade Federal do Rio Grande do Sul Porto Alegre, RS, Brazil.
| | - Jorge Wladimir Junqueira Bizzi
- Departamento de Ciências Morfológicas, Instituto de Biociências, Universidade Federal do Rio Grande do Sul Porto Alegre, RS, Brazil
| | - Jader Muller
- Departamento de Ciências Morfológicas, Instituto de Biociências, Universidade Federal do Rio Grande do Sul Porto Alegre, RS, Brazil
| | - Leandro Totti Cavazzola
- Departamento de Ciências Morfológicas, Instituto de Biociências, Universidade Federal do Rio Grande do Sul Porto Alegre, RS, Brazil
| |
Collapse
|
22
|
Niu ZX, Gao Q, Peng J, Shi H, Chen LQ. Diagnosis and surgical treatment of esophageal carcinoma with coexistent intrathoracic vascular malformations. Thorac Cancer 2014; 5:377-82. [PMID: 26767028 DOI: 10.1111/1759-7714.12103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 02/19/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The anomaly of intrathoracic large vessels might not only compress the esophagus resulting in dysphagia, but also hinder esophagectomy, even leading to uncontrolled massive hemorrhaging. This paper reviews our experience of seven patients with this diagnosis and their treatment. METHODS From January 2007 through January 2012, among patients admitted with esophageal carcinoma, there were seven patients confirmed to have coexisted intrathoracic vascular anomalies. They were six men and one woman, aged 52 to 63 (mean 58.42). The vascular anomalies included aberrant right subclavian artery (ARSA) in three cases, post-aortic left innominate vein (PALIV) in two cases, and one case each of right aortic arch (RAA) and pseudoaneurysm of aortic isthmus (PAAI). Their diagnosis, surgical strategy, and outcome were reviewed. RESULTS The vascular anomalies were missed by esophagography and endoscopy, but all identified by enhanced chest computed tomography (CT). Surgery was planned according to the anatomic features of the anomalies. ARSA did not need special management. RAA underwent left thoracotomy in order to dissect the aortopulmonary arterial ligament and to facilitate the mobilization of the esophagus. PAAI had preoperative aortic stenting to prevent unexpected aortic rupture. Prophylactic ligation of thoracic duct was performed on all patients and no postoperative chylothorax was documented. CONCLUSIONS The coexistence of intrathoracic vascular malformations with esophageal carcinoma is rare, but easily missed in routine X-ray and endoscopy. Enhanced chest CT must be performed to confirm. Surgery should be designed individually in consideration of the anatomic features of the vascular anomalies. A routine prophylactic ligation of the thoracic duct is recommended.
Collapse
Affiliation(s)
- Zhong-Xi Niu
- Department of Thoracic Surgery, West China Hospital, Sichuan University Chengdu, Sichuan, China
| | - Qiang Gao
- Department of Thoracic Surgery, West China Hospital, Sichuan University Chengdu, Sichuan, China
| | - Jun Peng
- Department of Thoracic Surgery, West China Hospital, Sichuan University Chengdu, Sichuan, China
| | - Hui Shi
- Department of Thoracic Surgery, West China Hospital, Sichuan University Chengdu, Sichuan, China
| | - Long-Qi Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University Chengdu, Sichuan, China
| |
Collapse
|
23
|
Increased prediction of right nonrecurrent laryngeal nerve in thyroid surgery using preoperative computed tomography with intraoperative neuromonitoring identification. World J Surg Oncol 2014; 12:262. [PMID: 25142438 PMCID: PMC4150955 DOI: 10.1186/1477-7819-12-262] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Accepted: 08/06/2014] [Indexed: 11/10/2022] Open
Abstract
Background A nonrecurrent laryngeal nerve (NRLN) is a rare but potentially serious anatomical variant. Although the incidence is reported to be 0.3% to 1.3%, it carries a much higher risk of palsy during thyroid surgery. The objective of this study is to investigate the usefulness of computed tomography (CT) for preoperative identification and intraoperative neuromonitoring identification (IONM) of NRLN in thyroid cancer patients. Methods The preoperative neck CT scans from 1,574 patients who needed thyroid surgery were examined. Absence of the brachiocephalic artery (BCA) and the presence of arteria lusoria were defined as positive with NRLN. Systematic intraoperative neuromonitoring (IONM) was also carried out for these 1,574 patients to localize and identify NRLN. A negative electromyography (EMG) response from lower vagal stimulation but a positive EMG response from the upper position indicated the occurrence of an NRLN. Results Nine NRLN (0.57%) were intraoperatively identified out of the 1,574 patients, and no patient with a NRLN showed preoperative clinical symptoms related to NRLN. Prior to the operation, surgeons identified only seven suspected NRLN cases based on identification of arteria lusoria. But a review of CT scans revealed that all cases could be identified by vascular anomalies. All patients were successfully detected at an early stage of operation using intraoperative neuromonitoring (IONM). Postoperative vocal cord function was normal in all patients. Conclusions CT of the neck is a reliable method for predicting NRLN before thyroid cancer surgery. However, some image features can be easily missed. Neurophysiology helps the surgeon to identify the NRLNs more precisely. Combining the two evaluation methods may decrease the incidence of nerve palsy, especially in cases of NRLN. Considering that CT is expensive, requires an X-ray, and achieves less information than ultrasound (US) concerning thyroid nodules, we suggest that applying US and IONM is more reasonable.
Collapse
|
24
|
Polguj M, Chrzanowski Ł, Kasprzak JD, Stefańczyk L, Topol M, Majos A. The aberrant right subclavian artery (arteria lusoria): the morphological and clinical aspects of one of the most important variations--a systematic study of 141 reports. ScientificWorldJournal 2014; 2014:292734. [PMID: 25105156 PMCID: PMC4102086 DOI: 10.1155/2014/292734] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/22/2014] [Accepted: 05/06/2014] [Indexed: 12/20/2022] Open
Abstract
The most important abnormality of the aortic arch is arguably the presence of an aberrant right subclavian artery (arteria lusoria). If this vessel compresses the adjacent structures, several symptoms may be produced. The aim of the study is to present the morphological and clinical aspects of the aberrant right subclavian artery. Three different databases searched for a review of pertinent literature using strictly predetermined criteria. Of 141 cases, 15 were cadaveric and 126 were clinically documented. The gender distribution of the subjects was 55.3% female and 44.7% male. The mean age of the patients at symptoms onset was 49.9 ± 19.4 years for all patients but 54.0 ± 19.6 years and 44.9 ± 18.1 years for female and male subjects, respectively (P = 0.0061). The most common symptoms in this group were dysphagia (71.2%), dyspnea (18.7%), retrosternal pain (17.0%), cough (7.6%), and weight loss (5.9%). The vascular anomalies coexisting with an arteria lusoria were truncus bicaroticus (19.2%), Kommerell's diverticulum (14.9%), aneurysm of the artery itself (12.8%), and a right sided aortic arch (9.2%). In conclusion, compression of adjacent structures by an aberrant right subclavian artery needs to be differentiated from other conditions presenting dysphagia, dyspnea, retrosternal pain, cough, and weight loss.
Collapse
Affiliation(s)
- Michał Polguj
- Department of Angiology, Medical University of Łódź, Narutowicza 60, 90-136 Łódź, Poland
| | - Łukasz Chrzanowski
- Department of Cardiology, Medical University of Łódź, Kniaziewicza 33, 90-153 Łódź, Poland
| | - Jarosław D. Kasprzak
- Department of Cardiology, Medical University of Łódź, Kniaziewicza 33, 90-153 Łódź, Poland
| | - Ludomir Stefańczyk
- Department of Radiology, Medical University of Łódź, Kopcińskiego 22, 90-153 Łódź, Poland
| | - Mirosław Topol
- Department of Normal and Clinical Anatomy, Medical University of Łódź, Narutowicza 60, 90-136 Łódź, Poland
| | - Agata Majos
- Department of Radiological and Isotopic Diagnosis and Therapy, Medical University of Łódź, Żeromskiego 113, 90-549 Łódź, Poland
| |
Collapse
|
25
|
Bicarotid Trunk: How Much Is “Not Uncommon”? Ann Thorac Surg 2014; 97:945-9. [DOI: 10.1016/j.athoracsur.2013.12.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 11/26/2013] [Accepted: 12/18/2013] [Indexed: 11/20/2022]
|
26
|
Lamb KM, Moudgill N, Whisenhunt AK, Ayad M, Abai B, Salvatore D, DiMuzio PJ. Hybrid endovascular treatment of an aberrant right subclavian artery with Kommerell aneurysm. Vascular 2014; 22:458-63. [PMID: 24493059 DOI: 10.1177/1708538113518531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aberrant right subclavian artery is a rare anatomical finding of abnormal embryologic development of the dorsal aorta and right subclavian artery. An associated aortic outpouching, or Kommerell diverticulum, may develop at the origin of the aberrant right subclavian artery. Given historically high rates of aneurysm rupture and mortality, early repair is indicated. Successful aneurysm exclusion can be accomplished with thoracic endovascular stent grafting following open carotid-subclavian bypass, maintaining upper extremities perfusion. Such hybrid techniques offer a decrease in mortality and complication rates. Herein, we describe a successful repair of a symptomatic (dysphagia, weight loss) aberrant right subclavian artery with Kommerell diverticulum using this hybrid open-endovascular approach.
Collapse
Affiliation(s)
- K M Lamb
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - N Moudgill
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - A K Whisenhunt
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - M Ayad
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - B Abai
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - D Salvatore
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - P J DiMuzio
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
| |
Collapse
|
27
|
Gafoor S, Stelter W, Bertog S, Sievert H. Fully percutaneous treatment of an aberrant right subclavian artery and thoracic aortic aneurysm. Vasc Med 2014; 18:139-44. [PMID: 23720037 DOI: 10.1177/1358863x13485985] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Treatment of an aberrant right subclavian artery (arteria lusoria) aneurysm is traditionally performed surgically or via a hybrid approach. To our knowledge, a fully percutaneous approach has not yet been reported. We describe the fully endovascular exclusion of an aberrant right subclavian artery and thoracic aortic aneurysm. This approach has the potential advantage of avoiding complications of an open surgical repair, particularly in patients of advanced age and/or with multiple comorbidities.
Collapse
|
28
|
Arrigoni SC, Willems TP, Mungroop HE, van den Heuvel F, Ebels T. Lusoria flap for the management of aortic coarctation in an eight-year-old child. World J Pediatr Congenit Heart Surg 2013; 4:302-4. [PMID: 24327502 DOI: 10.1177/2150135113480531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anomalous origin of right subclavian artery arising from the descending aorta is known as "arteria lusoria." The diagnosis in asymptomatic children is usually the by-product of other symptomatic-associated anomalies, such as aortic coarctation. We describe a case of an eight-year-old boy with juxtaductal aortic coarctation and rare origin of the arteria lusoria proximal to the aortic coarctation. The anomalous arteria lusoria was used as a flap to repair the aortic coarctation. To the authors' knowledge, this is the first reported application of lusoria flap in a young child (not newborn) with ductal aortic coarctation.
Collapse
Affiliation(s)
- Sara C Arrigoni
- Department of Congenital Cardiothoracic surgery, University Medical Center Groningen, the Netherlands
| | | | | | | | | |
Collapse
|
29
|
Obaid T, Kulkarni N, Pezzi TA, Turkeltaub AE, Pezzi CM. Coexisting right nonrecurrent and right recurrent inferior laryngeal nerves: a rare and controversial entity: report of a case and review of the literature. Surg Today 2013; 44:2392-6. [PMID: 24292653 DOI: 10.1007/s00595-013-0800-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Accepted: 08/05/2013] [Indexed: 10/26/2022]
Abstract
Variations in the course of the recurrent laryngeal nerve (RLN) can occur, including the development of a nonrecurrent inferior laryngeal nerve (NRILN). Rarely, both a right RLN and a right NRILN have been reported in the same patient, merging before they enter the larynx. A case is presented, including images, and the literature concerning this rare anatomical finding is reviewed, including studies suggesting alternative explanations for these cases. Fourteen previously reported cases of coexisting RLN and NRILN were identified, all involving the right side. Some cases were associated with an anomalous origin of the right subclavian artery and some were not. The alternative explanations that a communicating branch of the sympathetic nerve, which joins the RLN, is mistaken for an NRILN or that a collateral branch from an NRILN is mistaken for an RLN in these cases are also considered. Surgeons must be aware of these unusual variations to minimize nerve injury during neck surgery.
Collapse
Affiliation(s)
- Thaer Obaid
- Department of Surgery, Abington Memorial Hospital, 1245 Highland Avenue, Suite 604, Abington, PA, 19001, USA
| | | | | | | | | |
Collapse
|
30
|
Schaarschmidt M, Keßler J, Voigt R, Bormann A, Harms J. [Diagnostic odyssey in progressive dysphagia]. Radiologe 2013; 53:1107-9. [PMID: 24221698 DOI: 10.1007/s00117-013-2584-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- M Schaarschmidt
- Klinik für Allgemein-, Visceral- und Gefäßchirurgie, Klinikum Altenburger Land GmbH, Am Waldessaum 10, 04600, Altenburg, Deutschland,
| | | | | | | | | |
Collapse
|
31
|
Kimmel GL, Kimmel CA, Williams AL, DeSesso JM. Evaluation of developmental toxicity studies of glyphosate with attention to cardiovascular development. Crit Rev Toxicol 2013; 43:79-95. [PMID: 23286529 PMCID: PMC3581053 DOI: 10.3109/10408444.2012.749834] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 11/12/2012] [Accepted: 11/12/2012] [Indexed: 11/13/2022]
Abstract
The herbicide glyphosate has undergone multiple safety tests for developmental toxicity in rats and rabbits. The European Commission's 2002 review of available glyphosate data discusses specific heart defects observed in several individual rabbit developmental toxicity studies, but describes the evidence for a potential causal relationship as equivocal. The present assessment was undertaken to analyze the current body of information generated from seven unpublished rabbit studies in order to determine if glyphosate poses a risk for cardiovascular malformations. In addition, the results of six unpublished developmental toxicity studies in rats were considered. Five of the seven rabbit studies (dose range: 10-500 mg/kg/day) were GLP- and testing guideline-compliant for the era in which the studies were performed; a sixth study predated testing and GLP guidelines, but generally adhered to these principles. The seventh study was judged inadequate. In each of the adequate studies, offspring effects occurred only at doses that also caused maternal toxicity. An integrated evaluation of the six adequate studies, using conservative assumptions, demonstrated that neither the overall malformation rate nor the incidence of cardiovascular malformations increased with dose up to the point where severe maternal toxicity was observed (generally ≥150 mg/kg/day). Random occurrences of cardiovascular malformations were observed across all dose groups (including controls) and did not exhibit a dose-response relationship. In the six rat studies (dose range: 30-3500 mg/kg/day), a low incidence of sporadic cardiovascular malformations was reported that was clearly not related to treatment. In summary, assessment of the entire body of the developmental toxicity data reviewed fails to support a potential risk for increased cardiovascular defects as a result of glyphosate exposure during pregnancy.
Collapse
Affiliation(s)
| | | | | | - John M. DeSesso
- Exponent IncAlexandria, VA
- Georgetown University School of MedicineWashington, DCUSA
| |
Collapse
|
32
|
The surgical anatomy and clinical relevance of the neglected right lymphatic duct: review. The Journal of Laryngology & Otology 2013; 127:128-33. [PMID: 23298634 DOI: 10.1017/s0022215112002939] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The major lymphatic vessels may be damaged during neck dissection or other cervical surgery, resulting in chyloma or chyle fistula. While commonly considered to be predominantly a complication of left-sided surgery, the thoracic duct may be damaged on either side of the neck due to the extreme variability in the anatomy of the central lymphatic system. METHOD AND RESULTS This paper reviews the variable anatomy and embryology of the thoracic and right lymphatic ducts, particularly aspects relevant to head and neck surgery.
Collapse
|
33
|
Lovrenski J, Balj S, Simić D, Jecković M. Aberrant right common carotid and subclavian arteries causing tracheoesophageal compression combined with persistent left superior vena cava—case report. Clin Imaging 2012; 36:821-5. [DOI: 10.1016/j.clinimag.2011.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 12/14/2011] [Indexed: 10/28/2022]
|
34
|
Complex anomalies of type 1 proatlantal intersegmental artery and aortic arch variations. Surg Radiol Anat 2012; 35:177-80. [PMID: 22971758 DOI: 10.1007/s00276-012-1017-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 08/28/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE We report a case of type 1 proatlantal intersegmental artery (PIA) associated with multiple anomalies of the aortic arch, and discuss the possible embryonic mechanism and clinical importance of the multiple cerebrovascular variants in this patient. METHODS A 65-year-old woman with dizziness underwent cerebral magnetic resonance (MR) imaging and head and neck MR angiography using a 3-tesla scanner and computed tomography (CT) angiography using a 64-slice multidetector CT scanner. RESULTS MR and CT angiography demonstrated an aneurysm of the distal end of the azygos anterior cerebral arteries and hypoplasia of the proximal right vertebral artery (VA) with an anastomotic artery, between the right internal carotid artery (ICA) and distal right VA that passed through the foramen magnum, indicating a type 1 PIA. She also demonstrated an aberrant right subclavian artery (ARSA) with hypoplasia of the right VA, and the left VA arose directly from the aortic arch. CONCLUSION To our knowledge, this is the first report of a type 1 PIA associated with multiple vascular anomalies of the aortic arch, such as ARSA and origin of the left VA from the arch. In cases of persistent anastomoses between the carotid and vertebrobasilar arteries, such as PIAs, imaging examination should include the aortic arch to identify associated vascular variations.
Collapse
|
35
|
Pavlidis AN, Tsoukas A, Danias PG, Kallistratos MS, Levantakis I, Manolis AJ. Five-vessel aortic arch associated with a bicuspid aortic valve. J Cardiovasc Med (Hagerstown) 2012; 13:460-1. [DOI: 10.2459/jcm.0b013e3283474e85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
36
|
Reynolds TS, Donayre CE, Somma CG, Poggio WG, Kim KM, Nguyen T, White R. Endovascular management of blunt aortic injury with an associated aberrant right subclavian artery: a report of three cases. Ann Vasc Surg 2011; 25:979.e7-12. [PMID: 21764549 DOI: 10.1016/j.avsg.2011.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2010] [Revised: 04/25/2011] [Accepted: 05/12/2011] [Indexed: 11/17/2022]
Abstract
Traumatic rupture of the aorta in the rare setting of the aberrant right subclavian artery (ARSA) requires special consideration to prevent the occurrence of a devastating posterior cerebral circulation stroke. We present three cases managed by using an endovascular approach, with a discussion of important preoperative and operative issues. Three patients involved in motor vehicle collisions with multiple injuries were managed at two institutions. Computed tomography revealed transection of the aorta with incidental ARSA. All three cases were managed with a different approach. One patient did not undergo a preoperative bypass because imaging confirmed an adequate landing zone distal to the origin of the left subclavian artery. Two patients received preoperative right carotid-to-subclavian bypass for anticipated endograft coverage of both subclavian arteries to preserve single vertebral arterial flow. In one patient, an endovascular occlusion device was deployed in the ARSA before aortic endograft deployment. In the other, ARSA occlusion was performed 4 days later for a persistent type II endoleak. The patient who underwent bypass and preoperative ARSA occlusion suffered a fatal posterior circulation stroke shortly after surgery. The other two patients had no procedural complications and have not required any reinterventions at follow-up after 2 and 5 years. One patient is still undergoing rehabilitation after 5 years of follow-up for traumatic brain injury unrelated to the endograft repair. Although the incidence of ARSA is very low, preoperative imaging and assessment of cerebral blood flow are critical to prevent a perioperative stroke. Revascularization, if required to achieve a secure proximal landing zone, must be performed before endograft deployment. Bilateral subclavian revascularization is indicated if anomalies of the cerebral circulation are present.
Collapse
Affiliation(s)
- Tyler S Reynolds
- Division of Vascular and Endovascular Surgery, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| | | | | | | | | | | | | |
Collapse
|
37
|
Wang K, Zhang M, Sun J, Zhao S. A right-left aortic arch pattern made up by a bicarotid trunk, a left subclavian, a left vertebral and a right retroesophageal subclavian artery. Surg Radiol Anat 2011; 33:937-40. [PMID: 21594620 DOI: 10.1007/s00276-011-0824-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 05/07/2011] [Indexed: 11/29/2022]
Abstract
We present several vascular variations of the aortic arch vessels observed in a 35-year-old man during magnetic resonance angiography (MRA). The arterial branches of the aortic arch are from right to left: a bicarotid trunk, a left vertebral artery, a left subclavian artery, and a right retroesophageal subclavian artery. The right vertebral artery arises from the right carotid artery. Although a right retroesophageal subclavian artery has been reported in association with different anatomic variations of the aortic arch, to our knowledge this is the first MRA description of this particular combination of variations.
Collapse
Affiliation(s)
- Kai Wang
- Department of Respiratory Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China
| | | | | | | |
Collapse
|
38
|
Lee YS, Son EJ, Chang HS, Chung WY, Nam KH, Park CS. Computed Tomography Is Useful for Preoperative Identification of Nonrecurrent Laryngeal Nerve in Thyroid Cancer Patients. Otolaryngol Head Neck Surg 2011; 145:204-7. [DOI: 10.1177/0194599811406670] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective. Nonrecurrent laryngeal nerve (NRLN) is a risk factor for nerve injury during thyroid or parathyroid surgery and is usually associated with vascular anomalies. This study investigated the usefulness of computed tomography (CT) scans for preoperative identification of NRLN in thyroid cancer patients. Study Design. Case series with chart review. Setting. Academic university hospital. Subjects and Methods. Of the 6546 patients, 20 (0.3%) were intraoperatively identified with NRLN, and the medical records of 20 patients were reviewed retrospectively, with particular focus on preoperative CT findings. Results. All 20 cases were right-sided NRLN, and no clinical symptoms were observed preoperatively in any patient. Two patients had type I NRLN and 18 had type II NRLN. NRLN injury occurred in 1 patient at a point where the nerve was close to the superior thyroid artery. Prior to surgery, surgeons identified only 5 suspected NRLN cases based on identification of vascular anomalies on CT scans. However, this review of CT scans revealed that vascular anomalies could be identified on the scans of all patients. Conclusions. Neck CT scanning appears to be an excellent method for predicting NRLN cases. However, thorough examination of the scans, with particular attention to the neck and mediastinum vascular structures, is required.
Collapse
Affiliation(s)
- Yong Sang Lee
- Department of Surgery, Thyroid Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ju Son
- Department of Radiology, Thyroid Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Hang-Seok Chang
- Department of Surgery, Thyroid Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Youn Chung
- Department of Surgery, Thyroid Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Kee-Hyun Nam
- Department of Surgery, Thyroid Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Cheong Soo Park
- Department of Surgery, Thyroid Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
39
|
Thorpe SW, Hohl JB, Gilbert S, Tannoury CA, Lee JY. Aberrant right subclavian artery encountered during debridement of T2 osteomyelitis and associated phlegmon. Spine J 2011; 11:e6-10. [PMID: 21296290 DOI: 10.1016/j.spinee.2010.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Revised: 08/28/2010] [Accepted: 11/19/2010] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT An aberrant right subclavian artery is a rare congenital abnormality of the aortic arch. The anomalous origin for the right subclavian artery arises as the last branch of the thoracic aorta. In the most common anomalous form, the right subclavian artery passes posterior to both the esophagus and trachea as it crosses midline to supply the right upper extremity. The aberrant right subclavian artery is often not symptomatic, but it can cause dysphagia. PURPOSE To describe a case of an aberrant right subclavian artery discovered during debridement of T2 osteomyelitis. STUDY DESIGN Case report. METHODS A 49-year-old woman with diabetes was transferred to our institution with bilateral lower extremity weakness and incontinence of bowel and bladder function. Examination revealed no motor function in quadriceps, hamstrings, tibialis anterior, extensor hallucis longus, or gastrocsoleus complex of her bilateral lower extremities. RESULTS Spinal computed tomography scan showed pathologic collapse of the T2 vertebra. Magnetic resonance (MR) demonstrated an abscess and a phlegmon anterior to T2. Magnetic resonance also demonstrated spinal cord compression at the T2 vertebral level, and T2-weighted MR demonstrated the presence of spinal cord signal changes. CONCLUSIONS We report a rare case where an aberrant right subclavian artery was associated with a T2 osteomyelitis and paravertebral abscess. The intraoperative injury to this aberrant artery led to the eventual death of the patient. When planning an anterior approach to the upper thoracic region, surgeons should be aware of this anatomic variant of the subclavian artery and its associated aberrant recurrent laryngeal nerve.
Collapse
Affiliation(s)
- Steven W Thorpe
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave, Suite 1010, Pittsburgh, PA 15213, USA
| | | | | | | | | |
Collapse
|
40
|
Monahan TS. Nonrecurrent inferior laryngeal nerve. Vasc Endovascular Surg 2011; 45:90-1. [PMID: 21193467 DOI: 10.1177/1538574410389829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
41
|
Morris ME, Benjamin M, Gardner GP, Nichols WK, Faizer R. The Use of the Amplatzer Plug to Treat Dysphagia Lusoria Caused by an Aberrant Right Subclavian Artery. Ann Vasc Surg 2010; 24:416.e5-8. [DOI: 10.1016/j.avsg.2009.06.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 05/26/2009] [Accepted: 06/07/2009] [Indexed: 02/03/2023]
|
42
|
Myers PO, Fasel JHD, Kalangos A, Gailloud P. Arteria lusoria: developmental anatomy, clinical, radiological and surgical aspects. Ann Cardiol Angeiol (Paris) 2009; 59:147-54. [PMID: 19962688 DOI: 10.1016/j.ancard.2009.07.008] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2009] [Accepted: 07/15/2009] [Indexed: 11/26/2022]
Abstract
The left aortic arch with an aberrant right subclavian artery, or arteria lusoria, is the most common aortic arch anomaly, occuring in 0.5-2.5% of individuals. Four vessels arise sequentially from the aortic arch: the right common carotid artery, the left common carotid artery, the left subclavian artery and the aberrant right subclavian artery, which crosses upwards and to the right in the posterior mediastinum. It results from a disruption in the complex remodelling of the paired branchial arches, typically of the right dorsal aorta distal to the sixth cervical intersegmental artery. The diagnosis and differentiation of arch anomalies is based on findings at chest radiography in association with those at esophagography. It is usually asymptomatic. When symptomatic, it produces dysphagia lusoria or dyspnea and chronic coughing. Treatment is indicated for symptomatic relief of dysphagia lusoria and for prevention of complications due to aneurysmal dilatation.
Collapse
Affiliation(s)
- P O Myers
- Division of Cardiovascular Surgery, Geneva University Hospital, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland.
| | | | | | | |
Collapse
|
43
|
|
44
|
WAKABAYASHI Y, ISHII K, ABE T, KAMIDA T, FUJIKI M, KOBAYASHI H, NAGATOMI H. Aberrant Right Subclavian Artery With Left Carotid-Basilar Common Trunk. Neurol Med Chir (Tokyo) 2009; 49:447-8. [DOI: 10.2176/nmc.49.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Keisuke ISHII
- Department of Neurosurgery, Oita University Faculty of Medicine
| | - Tatsuya ABE
- Department of Neurosurgery, Oita University Faculty of Medicine
| | - Tohru KAMIDA
- Department of Neurosurgery, Oita University Faculty of Medicine
| | - Minoru FUJIKI
- Department of Neurosurgery, Oita University Faculty of Medicine
| | | | | |
Collapse
|
45
|
Taha MM, Nakahara I, Higashi T, Iwamuro Y, Watanabe Y, Taki W. Percutaneous angioplasty and stenting of subclavian arteries before surgical coronary revascularization in a patient with an aberrant right subclavian artery. J Neuroradiol 2008; 34:267-71. [PMID: 17640732 DOI: 10.1016/j.neurad.2007.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
An aberrant right subclavian artery occurs in less than 2% of the population. An associated stenosis of the subclavian artery carries a risk of subclavian-coronary steal in patients who undergo coronary revascularization. We report on the case of a 54-year-old man admitted to our hospital for a coronary artery bypass graft (CABG). Angiographic examination revealed bilateral subclavian-artery stenosis with an aberrant right subclavian artery, anomalous origin of the right vertebral artery from the right common carotid artery, and left vertebral-artery occlusion. The patient underwent successful bilateral subclavian angioplasty and stenting.
Collapse
Affiliation(s)
- M M Taha
- Department of Neurosurgery, Kokura Memorial Hospital, 1-1Kifunemachi, Kokurakita-ku, 802-8555 Kitakyusyu-shi Fukuoka, Japan, and Department of Neurosurgery, Zagazig University Hospital, Egypt.
| | | | | | | | | | | |
Collapse
|
46
|
Tsai IC, Tzeng WS, Lee T, Jan SL, Fu YC, Chen MC, Lin PC, Liao WC, Chen CCC. Vertebral and carotid artery anomalies in patients with aberrant right subclavian arteries. Pediatr Radiol 2007; 37:1007-12. [PMID: 17768615 DOI: 10.1007/s00247-007-0574-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Revised: 06/25/2007] [Accepted: 06/25/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is little published evidence regarding the patterns and prevalence of vertebral artery (VA) and common carotid artery (CCA) anomalies in patients with an aberrant right subclavian artery (ARSCA). OBJECTIVE To study the patterns and prevalence of VA and CCA anomalies in patients with ARSCA. MATERIALS AND METHODS In a 2-year period we reviewed the children referred with suspected vascular ring who had undergone multidetector-row CT. Patients with ARSCA were reviewed for VA and CCA patterns and their prevalence and relevance were calculated. RESULTS In total, 102 patients with ARSCA were identified. VA anomalies were present in 16 patients (15.7%), and CCA anomalies (common carotid trunk) in 21 patients (20.6%). In some patients with VA anomalies, the right VA arose from the right CCA and in some the left VA arose from the aortic arch. When the left VA arose from the aortic arch it was situated between the left CCA and the left SCA or between the left SCA and the ARSCA. CONCLUSION If neurointerventionalists understand these potential anomalies and their prevalence, time and contrast medium could be saved when catheterizing the VA and CCA in patients with ARSCA.
Collapse
Affiliation(s)
- I-Chen Tsai
- Department of Radiology, Taichung Veterans General Hospital, No.160, Sec. 3, Taichung Harbor Road, Taichung 407, Taiwan, Republic of China
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Ka-Tak W, Lam WWM, Yu SCH. MDCT of an Aberrant Right Subclavian Artery and of Bilateral Vertebral Arteries with Anomalous Origins. AJR Am J Roentgenol 2007; 188:W274-5. [PMID: 17312035 DOI: 10.2214/ajr.05.0694] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Wong Ka-Tak
- Department of Diagnostic Radiology & Organ Imaging, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR.
| | | | | |
Collapse
|
48
|
Chahwan S, Miller MT, Kim KA, Mantell M, Kirksey L. Aberrant Right Subclavian Artery Associated with a Common Origin of Carotid Arteries. Ann Vasc Surg 2006; 20:809-12. [PMID: 16779507 DOI: 10.1007/s10016-006-9074-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2006] [Revised: 01/13/2006] [Accepted: 02/17/2006] [Indexed: 11/26/2022]
Abstract
We present a patient with a rare anomaly of the aortic arch. Angiography revealed an aberrant right subclavian artery (aRSA) originating from the middle of the aortic arch. Angiography also demonstrated an anomalous origin of the left common carotid artery sharing a common trunk with the innominate artery and a large right vertebral artery arising from the right common carotid artery. Although this particular combination of anomalies has been reported in cadaver cases, to our knowledge this is the first premortem angiographic description of a patient in which an aRSA originates from the middle of the arch between the anomalous bovine arch trunk and the left subclavian trunk.
Collapse
Affiliation(s)
- Santiago Chahwan
- Division of Vascular Surgery, Department of Surgery, Graduate Hospital, Philadelphia, PA 19146, USA.
| | | | | | | | | |
Collapse
|
49
|
Brueck M, Bandorski D, Rauber K, Heidt M, Vogt P, Kramer W. [A 16-year-old patient with dysphagia]. Internist (Berl) 2006; 47:752-3, 755-7. [PMID: 16642341 DOI: 10.1007/s00108-006-1616-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A 16-year-old man with an 8-year history of progressive dysphagia was referred to hospital. There was no specific finding in his family history. Physical examination was unremarkable. Complete blood count, serum electrolytes, and liver and kidney function tests were normal. Barium swallow revealed an extrinsic impression of the upper esophagus posteriorly. Magnetic resonance angiography demonstrated an aberrant origin of the right subclavian artery, leaving the aorta below the left subclavian artery. The artery had a retroesophageal course, causing the esophageal narrowing. Due to the persistence and worsening of the patient's symptoms, resection and reconstructive bypass surgery were recommended. Surgical correction was performed through a combined right supraclavicular incision and left posterolateral thoracotomy. After application of a vascular clamp, the aberrant right subclavian artery was ligated almost at its origin, and an end-to-side anastomosis was made with the right common carotid artery. At the end of the operative procedure, good pulses were palpated in the right radial artery. Postoperatively, the patient tolerated a regular diet without symptoms of dysphagia and was discharged on postoperative day 7.
Collapse
Affiliation(s)
- M Brueck
- Medizinische Klinik I, Klinikum Wetzlar, Akademisches Lehrkrankenhaus der Justus-Liebig-Universität Giessen, Forsthausstrasse 1, 35578, Wetzlar.
| | | | | | | | | | | |
Collapse
|
50
|
Chen H, Shoumura S, Emura S. Bilateral thoracic ducts with coexistent persistent left superior vena cava. Clin Anat 2006; 19:350-3. [PMID: 16258968 DOI: 10.1002/ca.20178] [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: 11/12/2022]
Abstract
A case of bilateral thoracic ducts with coexistent persistent left superior vena cava (SVC) was identified in a 77-year-old Japanese female cadaver during dissection in a gross anatomy course. The persistent left SVC began at the lower surface of the left brachiocephalic vein, descended in front of the aortic arch, and drained into the right atrium through the coronary sinus. The right SVC was normal both in size and in position. The azygos vein, receiving the hemiazygos vein, opened into the right SVC. The accessory hemiazygos vein and the left superior intercostal vein united to form a common trunk, which drained into the left SVC. The left and right thoracic ducts began at the level of the 1st lumbar vertebra, ran upwards parallel and anterior to the vertebral column, and terminated at the venous angles of their corresponding sides. There was an anastomotic branch between them. The present case was considered to be very rare, since the persistent left SVC and bilateral thoracic ducts coexisted. The embryologic basis and clinical importance of this case are discussed.
Collapse
Affiliation(s)
- Huayue Chen
- Department of Anatomy, Gifu University Graduate School of Medicine, Gifu, 501-1194, Japan.
| | | | | |
Collapse
|