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Nedelcu AH, Lupu A, Moraru MC, Tarniceriu CC, Stan CI, Partene Vicoleanu SA, Haliciu AM, Statescu G, Ursaru M, Danielescu C, Ioniuc I, Tepordei RT, Lupu VV. Morphological Aspects of the Aberrant Right Subclavian Artery-A Systematic Review of the Literature. J Pers Med 2024; 14:335. [PMID: 38672962 PMCID: PMC11051064 DOI: 10.3390/jpm14040335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/09/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The aberrant origin of the right subclavian artery (ARSA), also known as the lusoria artery, is a congenital malformation with an incidence of 0.5-4.4%. Most cases are incidental due to minimal clinical manifestations. Computer tomography (CT) is important in diagnosing and evaluating these patients. MATERIALS AND METHODS We conduct a computerized search in two databases, PubMed and EMBASE, for articles published between 1 January 2022 and 31 December 2023, PROSPERO code: CRD42024511791. Eligible for inclusion were case reports and case series that presented the aberrant origin of the right subclavian artery. The main outcome was the highlighting of the morphological types of ARSA. In this context, we proposed a new classification system of this anomaly. The secondary outcome was the evaluation of the demographic distribution of the lusoria artery. RESULTS Our search identified 47 articles describing 51 patients with ARSA. The typical course for ARSA is retroesophageal, being registered in 49 out of 51 patients. This malformation is frequently associated with Kommerell diverticulum (15 out of 51), troncus bicaroticus (7 out of 51), and aberrant origins of the right vertebral artery (7 out of 51). We observed a higher incidence of the condition among women (32 out of 51) compared to men (19 out of 51). From a demographic point of view, ARSA is more frequent in the "44 to 57 years" and "58 to 71 years" age ranges. CONCLUSIONS ARSA is a congenital malformation resulting from a defect in the development of the aortic arches. The imaging studies such as computer tomography play a defined diagnostic role.
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Affiliation(s)
- Alin Horatiu Nedelcu
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
- Radiology Clinic, Recovery Hospital, 700661 Iasi, Romania
| | - Ancuta Lupu
- Department of Mother and Child, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (I.I.); (V.V.L.)
| | - Marius Constantin Moraru
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
| | - Cristina Claudia Tarniceriu
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
| | - Cristinel Ionel Stan
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
| | - Simona Alice Partene Vicoleanu
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
| | - Ana Maria Haliciu
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
| | - Gabriel Statescu
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
| | - Manuela Ursaru
- Department of Surgical Sciences I, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (M.U.); (C.D.)
- Radiology Clinic, “Sf Spiridon” County Clinical Emergency Hospital Iasi, 700661 Iasi, Romania
| | - Ciprian Danielescu
- Department of Surgical Sciences I, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (M.U.); (C.D.)
| | - Ileana Ioniuc
- Department of Mother and Child, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (I.I.); (V.V.L.)
| | - Razvan Tudor Tepordei
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
| | - Vasile Valeriu Lupu
- Department of Mother and Child, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (I.I.); (V.V.L.)
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Stejskal V, Vejvalkova K, Manethova M, Hudak A, Gunka I. Fibromuscular dysplasia of subclavian artery - a case report and mini-review. Cardiovasc Pathol 2024:107628. [PMID: 38453103 DOI: 10.1016/j.carpath.2024.107628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024] Open
Abstract
A case of a 40-year-old male patient with a right subclavian artery aneurysm of fibromuscular dysplasia origin is reported. The patient presented with thoracic outlet-like symptoms and underwent aneurysm resection. Microscopic examination revealed intimal and medial fibroplasia. Additional cases of fibromuscular dysplasia at this rare location are reviewed, indicating a male and right-sided predominance. The most frequent clinicopathological manifestation was an aneurysm, with the histopathological pattern characterized by medial fibroplasia. Treatment modalities included the use of either graft prosthesis or end-to-end anastomosis.
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Affiliation(s)
- Vaclav Stejskal
- The Fingerland Department of Pathology, University Hospital Hradec Kralove and Charles University, Faculty of Medicine in Hradec Kralove, Czech Republic.
| | - Katerina Vejvalkova
- The Fingerland Department of Pathology, University Hospital Hradec Kralove and Charles University, Faculty of Medicine in Hradec Kralove, Czech Republic
| | - Monika Manethova
- The Fingerland Department of Pathology, University Hospital Hradec Kralove and Charles University, Faculty of Medicine in Hradec Kralove, Czech Republic
| | - Alexander Hudak
- Department of Surgery, University Hospital Hradec Kralove and Charles University, Faculty of Medicine in Hradec Kralove, Czech Republic
| | - Igor Gunka
- Department of Surgery, University Hospital Hradec Kralove and Charles University, Faculty of Medicine in Hradec Kralove, Czech Republic
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Lee E, Jang YJ, Kim IS, Tae HJ, Sim J, Ahn D. Morphology of the aortic arch branching pattern in raccoon dogs ( Nyctereutes procyonoides, Gray, 1834). J Vet Sci 2024; 25:e32. [PMID: 38568833 PMCID: PMC10990908 DOI: 10.4142/jvs.23305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/21/2024] [Accepted: 02/12/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Aortic arch (AA) branching patterns vary among different mammalian species. Most previous studies have focused on dogs, whereas those on raccoon dogs remain unexplored. OBJECTIVES The objective of this study was to describe the AA branching pattern in raccoon dogs and compare their morphological features with those of other carnivores. METHODS We prepared silicone cast specimens from a total of 36 raccoon dog carcasses via retrograde injection through the abdominal aorta. The brachiocephalic trunk (BCT) branching patterns were classified based on the relationship between the left and right common carotid arteries. The subclavian artery (SB) branching pattern was examined based on the order of the four major branches: the vertebral artery (VT), costocervical trunk (CCT), superficial cervical artery (SC), and internal thoracic artery (IT). RESULTS In most cases (88.6%), the BCT branched off from the left common carotid artery and terminated in the right common carotid and right subclavian arteries. In the remaining cases (11.4%), the BCT formed a bicarotid trunk. The SB exhibited various branching patterns, with 26 observed types. Based on the branching order of the four major branches, we identified the main branching pattern, in which the VT branched first (98.6%), the CCT branched second (81.9%), the SC branched third (62.5%), and the IT branched fourth (52.8%). CONCLUSIONS The AA branching pattern in raccoon dogs exhibited various branching patterns with both similarities and differences compared to other carnivores.
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Affiliation(s)
- Euiyong Lee
- Department of Veterinary Medicine, College of Veterinary Medicine and Institute of Animal Transplantation, Jeonbuk National University, Iksan 54596, Korea
| | - Young-Jin Jang
- Department of Veterinary Medicine, College of Veterinary Medicine and Institute of Animal Transplantation, Jeonbuk National University, Iksan 54596, Korea
| | - In-Shik Kim
- Department of Veterinary Medicine, College of Veterinary Medicine and Institute of Animal Transplantation, Jeonbuk National University, Iksan 54596, Korea
| | - Hyun-Jin Tae
- Department of Veterinary Medicine, College of Veterinary Medicine and Institute of Animal Transplantation, Jeonbuk National University, Iksan 54596, Korea
| | - Jeoungha Sim
- Department of Nursing, College of Medical Science, Jeonju University, Jeonju 55069, Korea.
| | - Dongchoon Ahn
- Department of Veterinary Medicine, College of Veterinary Medicine and Institute of Animal Transplantation, Jeonbuk National University, Iksan 54596, Korea.
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Dorn C, Bender L, Sichtermann T, Minkenberg J, Franko M, Yousefian E, Wiesmann M, Stockero A, May R, Ridwan H, Nikoubashman O, Franz C. Comparison of artery diameters in the Aachen minipig serving as a human intracranial in vivo model. Lab Anim 2024; 58:65-72. [PMID: 37698341 DOI: 10.1177/00236772231169809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Minipigs are used as in vivo endovascular models, particularly in stroke and aneurysm research. However, detailed knowledge of the diameters of forelimb arteries that are commonly used as surrogates for human brain-supplying arteries are lacking. This study aimed to determine the diameters of forelimb and neck arteries in Aachen minipigs and to compare those to the diameters of human cerebral brain-supplying arteries in order to assess the validity of the Aachen minipig as a human intracranial in vivo model. We measured the diameters in the external carotid artery and eight different branches of the subclavian artery in 12 Aachen minipigs using angiographic imaging. Analysed arteries comprised the external carotid artery, axillary artery, brachial artery, subscapular artery first segment, subscapular artery second segment, external thoracic artery, caudal circumflex humeral artery, suprascapular artery and thoracodorsal artery. We compared these diameters to diameters of the following human brain-supplying arteries: terminal internal carotid artery (carotid-T and petrous segment), M1 segment of the middle cerebral artery, M2 segments of the middle cerebral artery, anterior cerebral artery, vertebral artery and basilar artery. Median diameters of porcine forelimb arteries ranged from 1.8 to 4.9 mm, and human brain supplying arteries ranged in diameter from 1.4 to 4.3 mm. Depending on the intended use, this allows porcine forelimb arteries to be selected which are statistically comparable to human brain-supplying vessels. In conclusion, we identified several equivalent arteries of the porcine subclavian branches that are comparable to human brain-supplying arteries. This may help to validate the minipig as a suitable in vivo model for neurovascular experiments.
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Affiliation(s)
- Christoph Dorn
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Germany
| | - Lara Bender
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Germany
| | - Thorsten Sichtermann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Germany
| | - Jan Minkenberg
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Germany
| | - Maximilian Franko
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Germany
| | - Ehsan Yousefian
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Germany
| | - Martin Wiesmann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Germany
| | - Andrea Stockero
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Germany
| | - Rebecca May
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Germany
| | - Hani Ridwan
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Germany
| | - Omid Nikoubashman
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Germany
| | - Christiane Franz
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Germany
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Montano A, Halicek M, Collier V, Reese B. Critical Left Subclavian Artery Stenosis With Retrograde Vertebral Flow: A Case Report and Literature Review. Cureus 2023; 15:e51027. [PMID: 38264376 PMCID: PMC10804909 DOI: 10.7759/cureus.51027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2023] [Indexed: 01/25/2024] Open
Abstract
Subclavian artery stenosis is a rare condition associated with significant morbidity and mortality, making prompt recognition and treatment essential. We present a case of left-sided subclavian artery occlusion with neurological symptoms, including vertigo, unsteady gait, and left upper extremity pain and paresthesia. The patient's symptoms had been progressing over several months. Her risk factors included age, hyperlipidemia, and poorly controlled blood pressure with resultant arteriosclerosis throughout her vasculature. An arteriogram demonstrated critical stenosis of the left subclavian with retrograde flow through the left vertebral artery. Aspirin and clopidogrel were initiated prior to successful balloon angioplasty and stenting. After stent placement, the patient had minimal residual subclavian stenosis and anterograde vertebral artery flow. In this case report, we discuss clinical presentation, typical examination and imaging findings, and treatment options for subclavian stenosis including medical management and revascularization procedures.
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Affiliation(s)
- Andreas Montano
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
| | | | - Victor Collier
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
| | - Brooke Reese
- Medicine, Edward Via College of Osteopathic Medicine, Spartanburg, USA
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Yuan SM, Yuan AH. Mycotic subclavian artery aneurysms: a scoping review. Postepy Kardiol Interwencyjnej 2023; 19:303-310. [PMID: 38187490 PMCID: PMC10767570 DOI: 10.5114/aic.2023.133235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/27/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Mycotic subclavian artery aneurysms (SAAs) are a very rare disorder. Aim To provide an overview of current knowledge on clinical features, management strategies and outcome evaluations of mycotic SAAs. Material and methods The study materials were based on comprehensive literature retrieval of publications of mycotic SAAs published between 2000 and 2023. Results Contaminated mechanical injuries and abscess erosions of the arterial walls are mechanisms of mycotic SAAs. The diagnosis relies on detection of pathogenic microorganisms by cultures or microbiological investigations of blood, other fluids and infected tissues as well as medical imaging visualization. The indications for an interventional therapy were poor general condition, high surgical risk, and rescue exclusion for a ruptured pseudoaneurysm. Three (9.1%) pre-treatment deaths were a result of sudden rupture of the mycotic SAAs and thus they lost the opportunity of treatment. All post-treatment deaths occurred in the interventional patient group, whereas the causes of death seemed to be unrelated to mycotic SAAs per se or to treatments of choice. Patient outcome evaluations revealed no significant difference between different treatments of choice. No significant predictive risk factors were responsible for patient outcomes. Conclusions Once a diagnosis of mycotic SAA is made, sensitive antibacterial drugs are applied immediately to control the infection and control aneurysmal progression. Early treatment is conducted as soon as possible to avoid aneurysmal rupture. A decision on treatment of choice is made based on the patient's specific condition. Antibacterial drug use is continued for about 6 weeks after surgical or interventional therapy.
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Affiliation(s)
- Shi-Min Yuan
- The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, China
| | - Ai-Hong Yuan
- Department of Anesthesiology (2017), the First Clinical College, China Medical University, Shenyang, Liaoning Province, China
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Nakajima H, Momose T, Misawa T. A possible mechanism and predictors of forming looped guidewire between the right subclavian and brachiocephalic artery during coronary angiography with right radial artery access: An original paper. Sci Prog 2023; 106:368504231213801. [PMID: 37960890 PMCID: PMC10647970 DOI: 10.1177/00368504231213801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
OBJECTIVES Guidewire occasionally creates a loop-like appearance between the right subclavian artery and brachiocephalic artery when performing coronary angiography (CAG) with right radial artery (RtRA) access. We called this occurrence a looped guidewire at the brachiocephalic artery (looped GW at BA). It is associated with difficulties in catheter manipulation. This study aimed to assess the predictors of forming a looped GW at the BA. METHODS We examined 175 (mean age, 71.3 ± 9.5 years; 74.9% men) consecutive patients who underwent elective CAG with the RtRA access. Looped GW at the BA was defined as a loop-like appearance of the 0.035-inch GW between the right subclavian and brachiocephalic artery on a frontal view or left anterior oblique. To identify the predictors of looped GW at BA, patient characteristics and examination data obtained before CAG were compared between patients with and without looped GW at the BA. RESULTS The prevalence of looped GW at BA was 10.9%. The cardio-ankle vascular index (CAVI), which reflects arterial stiffness, was significantly different in patients with or without looped GW at BA (9.8 ± 1.0 vs. 8.9 ± 1.5, p = 0.0092). The area under the receiver-operating characteristic curve of CAVI to predict looped GW at BA was 0.745, with 0.94 sensitivity and 0.57 specificity in a cutoff point of CAVI ≥9.0. CONCLUSIONS Looped GW at BA can be ruled out by CAVI and is associated with high arterial stiffness.
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Affiliation(s)
- Hiroyuki Nakajima
- Department of Cardiology, Nagano Matsushiro General Hospital, Nagano City, Japan
| | - Tomoyasu Momose
- Department of Cardiology, Nagano Matsushiro General Hospital, Nagano City, Japan
| | - Takuo Misawa
- Department of Cardiology, Nagano Matsushiro General Hospital, Nagano City, Japan
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Kumins NH, Ambani RN, Bose S, King AH, Cho JS, Colvard B, Kashyap VS. Anatomic Utility of Single Branched Thoracic Endograft During Thoracic Endovascular Aortic Repair. Vasc Endovascular Surg 2023; 57:680-688. [PMID: 36961838 DOI: 10.1177/15385744231165988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
INTRODUCTION Single branched thoracic endografts (SBTEs) have been designed for pathology requiring zone 2 seal during thoracic endovascular aortic repair (TEVAR). Numerous criteria must be met to allow for their implantation. Our aim was to analyze anatomic suitability for a next generation SBTE. METHODS We reviewed 150 TEVAR procedures between 2015 and 2019. Proximal seal was: zone 0 in 21 (16%), zone 1 in 4 (3%), zone 2 in 52 (40%), zone 3 in 45 (35%), and zone 4 or distal in 7 (5%). We analyzed the Zone 2 patient's angiograms and CT angiograms using centerline software to measure arterial diameters and length in relation to the left common carotid artery (LCCA), left subclavian artery (LSA) and proximal extent of aortic disease to determine if patients met anatomic criteria of a novel SBTE. RESULTS Zone 2 average age was 64.4 ± 16.3 years; 34 patients were male (65%). Indications for repair were aneurysm (N = 9, 17%), acute dissection (N = 14, 27%), chronic dissection with aneurysmal degeneration (N = 7, 13%), intramural hematoma (N = 9, 17%), penetrating aortic ulcer (N = 5, 10%), and blunt traumatic aortic injury (BTAI, N = 8, 15%). LSA revascularization occurred in 27 patients (52%). Overall, 20 (38.5%) of the zone 2 patients met anatomic criteria. Patients with dissection met anatomic criteria less frequently than aneurysm (33% [10 of 30] vs 64% [9 of 14]). Patients treated for BTAI rarely met the anatomic criteria (1 of 8, 13%). The main anatomic constraints were an inadequate distance from the LCCA to the LSA takeoff and from the LCCA to the start of the aortic disease process. CONCLUSION Less than half of patients who require seal in zone 2 met criteria for this SBTE. Patients with aneurysms met anatomic criteria more often than those with dissection. The device would have little applicability in treating patients with BTAI.
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Affiliation(s)
- Norman H Kumins
- Department of Vascular Surgery, The Heart and Vascular Institute, The Cleveland Clinic, Cleveland, OH, USA
| | - Ravi N Ambani
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, USA
| | - Saideep Bose
- Division of Vascular and Endovascular Surgery, Department of Surgery, St Louis University, St Louis, MO, USA
| | - Alexander H King
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, USA
| | - Jae S Cho
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, USA
| | - Benjamin Colvard
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, USA
| | - Vikram S Kashyap
- Division of Vascular Surgery, Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI, USA
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Alselaim N, Gheshayan SB, Saleem MB, Alwahbi A. Bullet embolization from the right subclavian artery to the right common femoral artery. J Surg Case Rep 2023; 2023:rjad606. [PMID: 37942339 PMCID: PMC10629870 DOI: 10.1093/jscr/rjad606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/05/2023] [Indexed: 11/10/2023] Open
Abstract
Bullet embolization from a gunshot wound is a rare entity in trauma patients. We report a case of a 37-year-old female patient who was brought to the trauma unit after sustaining multiple gunshots to the chest and abdomen. Followed by embolization of the bullet from the right subclavian artery to the right common femoral artery. Had successful retrieval of the bullet via a transverse arteriotomy.
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Affiliation(s)
- Nahar Alselaim
- Department of General Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Khashem Al Aan, Prince Jaber Al Sabah Street, Riyadh 11426, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Khashem Al Aan, Prince Jaber Al Sabah Street, PO Box 22490, Riyadh,11426, Saudi Arabia
- King Abdullah International Medical Research Center, Khashem Al Aan, Prince Jaber Al Sabah Street, Riyadh 11426, Saudi Arabia
| | - Sultanah Bin Gheshayan
- Department of General Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Khashem Al Aan, Prince Jaber Al Sabah Street, Riyadh 11426, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Khashem Al Aan, Prince Jaber Al Sabah Street, PO Box 22490, Riyadh,11426, Saudi Arabia
- King Abdullah International Medical Research Center, Khashem Al Aan, Prince Jaber Al Sabah Street, Riyadh 11426, Saudi Arabia
| | - Moneera Bin Saleem
- Department of Surgery, King Abdullah bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Airport Road, King Khalid International Airport, Riyadh 11564, Saudi Arabia
| | - Abdullah Alwahbi
- Department of Vascular Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Khashem Al Aan, Prince Jaber Al Sabah Street, Riyadh 11426, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Khashem Al Aan, Prince Jaber Al Sabah Street, PO Box 22490, Riyadh,11426, Saudi Arabia
- King Abdullah International Medical Research Center, Khashem Al Aan, Prince Jaber Al Sabah Street, Riyadh 11426, Saudi Arabia
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Van Nut L, Vinh PX, Vuong NL. Endovascular Treatment for Subclavian Artery Stenosis and Occlusion: A Single-Center Retrospective Study. Cureus 2023; 15:e44699. [PMID: 37809157 PMCID: PMC10552060 DOI: 10.7759/cureus.44699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Subclavian artery stenosis and occlusion are common arterial diseases in the upper extremities, with atherosclerosis being the main cause. Endovascular treatment has emerged as a promising alternative to open surgical repair, but data are limited. This study aimed to evaluate the safety and effectiveness of endovascular procedures in the treatment of subclavian artery lesions at a tertiary vascular center in Vietnam. METHODS A retrospective analysis was conducted on patients who underwent endovascular treatment for symptomatic subclavian artery stenosis or occlusion between October 2013 and April 2022. Clinical characteristics, procedural details, short- and long-term outcomes, and patency rates were assessed. RESULTS Twenty-five patients were included in the study, with a mean age of 56.8 years. The majority of patients had risk factors for atherosclerosis, and all presented with symptoms related to subclavian artery disease. The endovascular procedures were successful in 96% of cases, with a low complication rate of 8%. During a median follow-up of 43 months, the overall patency rate was 92% at three years. CONCLUSION Endovascular treatment of subclavian artery stenosis and occlusion is a safe and effective option, with excellent long-term patency rates. These findings support the use of percutaneous revascularization as the first-line therapy, particularly in experienced centers. Further studies with larger sample sizes and longer follow-up periods are needed to confirm these results.
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Affiliation(s)
- Lam Van Nut
- Department of Vascular Surgery, Cho Ray Hospital, Ho Chi Minh City, VNM
| | - Pham Xuan Vinh
- Thoracic and Vascular Department, Thu Duc City Hospital, Ho Chi Minh City, VNM
| | - Nguyen Lam Vuong
- Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
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11
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Akuma O, Akuma C, Addi Palle LR, Carredo CKC, Savul S, Khawer S, Khan A. Subclavian Artery Pseudoaneurysm in an Eight-Year-Old Boy: A Rare Case Report and Review of Literature. Cureus 2023; 15:e41488. [PMID: 37551239 PMCID: PMC10404339 DOI: 10.7759/cureus.41488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 08/09/2023] Open
Abstract
Pseudoaneurysms, also known as fake aneurysms, are balloon-like bulges that develop in the arteries and veins. This can happen due to injury, surgery, infection, or other conditions that damage blood vessels. Pseudoaneurysms are usually asymptomatic but can bleed and be painful. Left untreated, they can lead to severe complications such as thrombus formation and distant embolization. Subclavian pseudoaneurysms are rare, which can lead to potentially life-threatening complications of traumatic or iatrogenic injuries to the subclavian artery, such as catheterization. Prompt diagnosis and management are essential to avoid devastating outcomes. We report the case of a pediatric patient who developed a subclavian pseudoaneurysm after neck trauma and was successfully treated with endovascular embolization. This case highlights the importance of timely management and vigilant monitoring for this rare but potentially life-threatening condition.
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Affiliation(s)
| | - Chinaza Akuma
- Public Health, Chamberlain University, College of Health Professions, Chicago, USA
| | | | | | - Subhan Savul
- Internal Medicine, Ziauddin University, Karachi, PAK
| | | | - Aadil Khan
- Department of Internal Medicine, Lala Lajpat Rai Hospital, Kanpur, IND
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12
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Delaveridou E, Simichanidou A, Galanis S, Nikolaidou O. Life threatening, subclavian artery mycotic aneurysm rupture into a gigantic supraclavicular abscess in an intravenous drug user. Clin Med (Lond) 2023; 23:267-269. [PMID: 38614783 DOI: 10.7861/clinmed.2023-0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Subclavian artery injuries are sporadic, and the most common aetiology is trauma. Self-injury of the vessel in those misusing intravenous drugs is a rare complication, as most reports describe injury to the femoral artery. Thus, erosion and potential rupture of the arterial wall is possible due infection and phlegmon or abscess formation. We present a case of a young, female, hemodynamically unstable intravenous drug user admitted to the emergency department with a life-threatening, purulent haemorrhagic mass located at her right lateral cervical region. The patient admitted an inadvertent arterial puncture 10 days prior and an effort to self-manage the bleeding with the application of self-pressure and antibiotics. Computed tomography arteriogram of the neck revealed a gigantic, multicompartment, thick-walled collection with hyperdense fluid in her right supraclavicular region while active extravasation derived from the right subclavian artery was evident in late arterial phase. The patient was treated with endovascular graft stenting, despite the given presence of infection, as a salvage operation due to time limitation in open surgical repair.
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Affiliation(s)
| | - Anna Simichanidou
- 'George Papanikolaou' General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Stavros Galanis
- 'George Papanikolaou' General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Olga Nikolaidou
- 'George Papanikolaou' General Hospital of Thessaloniki, Thessaloniki, Greece.
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13
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Schmiedl A, Buchhorn A, Schönberger M. The relationship between the subclavian vessels and brachial plexus and the overlying clavicle: Anatomical study with application to plate osteosynthesis. Clin Anat 2023; 36:377-385. [PMID: 36104939 DOI: 10.1002/ca.23948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/12/2022] [Accepted: 08/30/2022] [Indexed: 11/05/2022]
Abstract
A subclavian artery aneurysm after clavicle fracture and plate osteosynthesis in a suspected case of a screw that was too long led us to investigate body donor cadavers. The aim was to verify clavicle variability, and the course of the neurovascular bundle in relation to the clavicle and to the osteosynthesis plate, in order to clarify safe zones for plate and screw fixation. We used one fresh frozen and 25 embalmed donors for in situ measurements: (1) length and craniocaudal thickness of the clavicle, (2) distances between the sternal end of the clavicle and the center of parts of the neurovascular bundle. The clavicle was 15.15 cm long. The mean distances from the sternal end of the clavicle were 5.62 cm to the subclavian vein, 6.75 cm to the subclavian artery and 8.42 cm to the cords of the brachial plexus. The subclavius muscle was 1 cm thick. Because of sex differences in length and distances, we recorded the distances between the sternal end and parts of the neurovascular bundle as ratios of clavicle length (at-risk area) to provide sex-independent parameters: 0.379 for the vein, 0.449 for the artery and 0.554 for the nerve. The neurovascular bundle runs below the clavicle between the medial fourth and three fifths of clavicle length. To avoid iatrogenic neurovascular injuries, special caution is necessary during drilling and screwing the osteosynthesis. We also recommend using screws shorter than 1.4 cm.
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Affiliation(s)
- Andreas Schmiedl
- Institute of Functional and Applied Anatomy, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, Germany
| | - Andreas Buchhorn
- Institute of Functional and Applied Anatomy, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, Germany
| | - Michael Schönberger
- Arbitration Board for Medical Liability Issues of the North German Medical Associations, Hannover, Germany
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14
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Bakir M, Dawalibi A, Elhossiny AH, Behiery A. A Rare Case Report of a Vertebral Artery Variant Arising From the Aorta With Its Clinical Significance: An Uncommon Anatomy Unveiled. Cureus 2023; 15:e37716. [PMID: 37206501 PMCID: PMC10191458 DOI: 10.7759/cureus.37716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
The vertebrobasilar (VB) system, comprising two vertebral arteries and one basilar artery, is responsible for providing vital vascular supply to the central nervous system structures. Disruption in this network can lead to fatal neurologic outcomes, and variations in the origin of vessels may contribute to unexplained symptoms of clinical relevance. Therefore, an extensive understanding of the VB system's anatomy and its variations is crucial for diagnosing neurological disorders. Here, we report a case of a vertebral artery variant arising from the aortic arch proximal to the left subclavian artery in the cadaver of a 50-year-old male, discovered incidentally during a teaching dissection session. We also discuss the clinical pathophysiology and the relevance of the neurological symptoms in relation to the anomaly.
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Affiliation(s)
- Mohamad Bakir
- College of Medicine, Alfaisal University, Riyadh, SAU
| | | | | | - Ayman Behiery
- Department of Anatomy, Alfaisal University, Riyadh, SAU
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15
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Cui HJ, Wu YF. Proximal right subclavian artery aneurysms: A case report and review of the literature. Vascular 2023:17085381231166582. [PMID: 36960791 DOI: 10.1177/17085381231166582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
BACKGROUND Subclavian aneurysms are rare in clinic; right subclavian artery aneurysms (SAAs) are more common than left SAAs in clinical practice. Although the causes and methods of treating subclavian aneurysms have been studied, it is still unknown how they form naturally. OBJECTIVE While describing the uncommon subclavian aneurysm, examine the pertinent literature to discuss its etiology and treatment outcomes, and offer some recommendations for this patient's treatment plan. METHODS In this case report, we describe a man patient who had a right subclavian proximal aneurysm that was discovered by accident. No clear clinical symptoms or signs were present in the patient. Upon admittance, an examination revealed an aneurysm in the vertebral artery but no peripheral embolization or compression symptoms. The patient refused operation, so we opted for follow-up instead. RESULT The patient took an ultrasound examination at our first follow-up appointment 3 months after discharge, and the results showed no thrombosis or appreciable aneurysm enlargement. Follow-up appointments for 6 months and a year have begun. CONCLUSION Follow-up is a good method to monitor the course of subclavian aneurysms without a clear indication for surgery when there is a clear operation mode and risk.
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Affiliation(s)
- Hong-Jie Cui
- Department of Vascular Surgery, 71044Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ying-Feng Wu
- Department of Vascular Surgery, Luhe Hospital Affiliated to Capital Medical University, Beijing, China
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16
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Sadri BS, Low DW, Jackson OA, Jackson BM, Belkin N. Subclavian to carotid artery bypass for a case of ocular ischemic syndrome. Vascular 2023:17085381231164015. [PMID: 36917226 DOI: 10.1177/17085381231164015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
BACKGROUND Ocular Ischemic Syndrome (OIS) is a rare, vision threatening condition associated with severe carotid artery disease. There are few cases of OIS reported in the literature. METHODS We present the case of a 54-year-old male with history of multiple previous carotid interventions including a right carotid stent, who presented with right-sided OIS. RESULTS CTA and angiogram showed a severe calcific plaque causing restenosis of the right carotid stent, with a patent right internal carotid artery (ICA) in the very distal neck. The right common carotid artery (CCA) was patent but diseased with ulcerated plaque extending proximally to below the level of the clavicle. The left CCA was chronically occluded from its origin all the way to the bifurcation. Given our patient's surgical history, the imperative to revascularize the ipsilateral carotid, and a diffusely diseased ipsilateral CCA, he was successfully treated with an ipsilateral subclavian to internal carotid bypass. CONCLUSION There is paucity of data regarding the best approach for carotid revascularization in OIS. This case report discusses our unique perioperative decision making as well as relevant literature.
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Affiliation(s)
- Babak S Sadri
- Department of Surgery, 1147Lehigh Valley Hospital, Allentown, PA, USA
| | - David W Low
- Division of Plastic Surgery, 21798Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Oksana A Jackson
- Department of Surgery, Division of Plastic, Reconstructive and Oral Surgery, 6567The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Nathan Belkin
- Division of Plastic Surgery, 21798Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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17
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Jang YJ, Sim JH, Lee Y, Ahn D. Morphology of aortic arch branching patterns in the Eurasian Otter (Lutra lutra, Linnaeus, 1758). J Vet Med Sci 2023; 85:399-406. [PMID: 36792211 PMCID: PMC10139791 DOI: 10.1292/jvms.22-0517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
In this study, we investigated the aortic arch (AA) branching pattern in the Eurasian otter (Lutra lutra). We performed arterial silicone casting of the AA of 18 Eurasian otters (8 males and 10 females). We analyzed the AA branching pattern at three levels: the AA, brachiocephalic trunk (BCT), and subclavian artery (SB), using different classification methods at each level. We introduced new criteria for classifying the SB branching pattern applicable for Eurasian otter and other carnivores based on the sequence of the four main branches: vertebral artery (VT), internal thoracic artery (IT), costocervical artery (CCT), and superficial cervical artery (SC). In all Eurasian otters, two major branches emerged directly from the AA, i.e., the BCT and left SB. The BCT branched off the left common carotid artery and terminated in the right common carotid artery and right SB in 17 of 18 Eurasian otters; the BCT formed a bicarotid artery in the remaining case. The SBs showed various branching patterns, with the main branching pattern involving branching to the VT and IT at the same position, followed by the CCT and SC. The SB branching pattern in the Eurasian otter differed from that in dogs in that the two first branching arteries were VT and IT, rather than VT and CCT. Here, we present the anatomical characteristics of the AA branching patterns in the Eurasian otter and new analysis methods applicable for comparative studies of other carnivores.
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Affiliation(s)
- Young-Jin Jang
- Department of Veterinary Medicine and Bio-safety Research Institute, Jeonbuk National University
| | - Jeong-Ha Sim
- Department of Nursing, College of Medical Science, Jeonju University
| | - Youngduk Lee
- Department of Companion Animal, Busan Women's University
| | - Dongchoon Ahn
- Department of Veterinary Medicine and Bio-safety Research Institute, Jeonbuk National University
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18
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Beloyartsev DF, Adyrkhaev ZA, Fagamov RR. [Treatment of atherosclerotic lesion of the first segment of subclavian artery]. Khirurgiia (Mosk) 2023:95-102. [PMID: 38088846 DOI: 10.17116/hirurgia202312195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Severe subclavian artery lesion is an important medical and social problem worsening the quality of life and leading to dire consequences. Vertebrobasilar insufficiency is the main syndrome of lesion of the first segment of subclavian artery. About 20% of all ischemic strokes occur in vertebrobasilar basin. At present, surgical treatment of asymptomatic patients with severe lesion of the 1st segment of subclavian artery is still debatable. Open surgery is optimal for occlusion of this vascular segment. Carotid-subclavian transposition is a preferable option with favorable in-hospital and long-term results. However, carotid-subclavian bypass is an equivalent alternative in case of difficult transposition following anatomical and topographic features of vascular architectonics. Endovascular treatment is preferable for isolated subclavian artery stenosis and should certainly include stenting.
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Affiliation(s)
- D F Beloyartsev
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Z A Adyrkhaev
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - R R Fagamov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
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19
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Gooding RC, Hines GL. A Case of Right Subclavian Artery Agenesis. Aorta (Stamford) 2022; 10:131-134. [PMID: 36318934 PMCID: PMC9626035 DOI: 10.1055/s-0042-1743534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors present a 12-year-old male with an asymptomatic absence of the proximal right subclavian artery. On physical examination, his right brachial, radial, and ulnar pulses were diminished compared with the left side. Computed tomographic angiography revealed that the right subclavian artery was supplied from the anterior right internal mammary artery. A description of the acquired and congenital aortic arch anomalies and thoracic outlet syndrome differential diagnoses is provided.
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Affiliation(s)
- Rose C. Gooding
- Department of Surgery, New York University Langone Hospital – Long Island, Mineola, New York,Address for correspondence Rose Gooding, MD Department of Surgery, NYU Langone Hospital – Long Island222 Station Plaza North, Suite 300, Mineola, NY 11501
| | - George L. Hines
- Department of Surgery, New York University Langone Hospital – Long Island, Mineola, New York
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20
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Chen Y, Li W, Li K. Computed Tomography Angiography in the Diagnosis of Subclavian-Vertebral Artery Steal. Int J Gen Med 2022; 15:7951-7959. [PMID: 36317100 PMCID: PMC9617550 DOI: 10.2147/ijgm.s384470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose Computed tomography angiography (CTA) is commonly used in the diagnosis and evaluation of subclavian steal (SS). However, the abnormal manifestations of vertebral artery (VA) in SS on CTA are vastly under-recognized and prone to misdiagnosis. We reported for the first time the abnormal CTA manifestations of VA in SS, and evaluated the value and pitfalls of CTA in the diagnosis of SS, aiming to avoid misdiagnosis and facilitate correct diagnosis of SS using CTA. Patients and Methods This study retrospectively included 19 patients diagnosed with SS using carotid duplex sonography (CDS) and digital subtraction angiography (DSA) between 2018 and 2022 at a tertiary neurology clinic in Chongqing, China. Their CDS, DSA and CTA results were collected and analyzed. The diagnostic consistency between CTA and DSA in grading subclavian artery stenosis was evaluated, and the CTA manifestations of VA were summarized. Results All patients presented subclavian steno-occlusion on the affected side, without steno-occlusion of the contralateral subclavian artery or bilateral VA on DSA. A high concordance was observed between CTA and DSA in grading subclavian artery stenosis (Kappa = 0.825, P = 0.000). However, only 26.3% of patients presented normal VA on CTA, whereas 73.7% of patients presented shallow VA ipsilateral to subclavian steno-occlusion. A 28.6% of patients with shallow VA were misdiagnosed as having vertebral arteriopathy. The presence of shallow VA had no significant correlation with age, gender, severity of subclavian artery stenosis, diameter of VA or model of CT scanner (all P>0.05). Although not statistically significant, the incidence of shallow VA increased with higher SS grade. Conclusion Carotid CTA is highly accurate for diagnosing subclavian steno-occlusion, whereas shallow VA is the pitfall of CTA in diagnosing SS. It is important to improve the recognition of shallow VA to avoid misdiagnosis.
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Affiliation(s)
- Yanru Chen
- Neurology Department, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China,Correspondence: Yanru Chen, Neurology Department, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Road, Yuzhong District, Chongqing, 400010, People’s Republic of China, Tel +86 13983100640, Email
| | - Wenqi Li
- Neurology Department, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Kunhua Li
- Radiology Department, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
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21
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Ostrowski P, Bonczar M, Przybycień W, Zamojska I, Kołodziejczyk B, Walocha J, Koziej M. An aberrant right subclavian artery in a 63-year-old male cadaver. Folia Morphol (Warsz) 2022; 82:726-731. [PMID: 36178279 DOI: 10.5603/fm.a2022.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 11/25/2022]
Abstract
An aberrant right subclavian artery (ARSA), also called "arteria lusoria", is described as a right subclavian artery (RSA) with a retro-oesophageal course that most frequently originates as the most distal branch of the aortic arch. The aim of the following study was to present and thoroughly describe a case of an ARSA, its course, branches, and relation to the surrounding anatomical structures and discuss the clinical significance and embryology of this variant. During routine dissection, a 63-year-old male cadaver with an abnormal variant of the RSA was found. The RSA branched off from the aortic arch as the most distal branch. Subsequently, it coursed posteriorly to the trachea and oesophagus at the level of T2 and T3. Abnormalities in the branching pattern of the RSA were also discovered, such as the right vertebral artery originating from the right common carotid artery as its first branch. This study presents a case of an ARSA, which is a rare anatomical variant of the branches of the aortic arch. The course and branching pattern of an aberrant subclavian artery is quite variable, and each variant can be associated with different possible complications. Furthermore, the ARSA is associated with other cardiovascular anomalies, such as the Kommerell's diverticulum. Therefore, knowledge about the possible variations of this anomaly may be of great importance for physicians who encounter this variant in their practice.
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Affiliation(s)
- P Ostrowski
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - M Bonczar
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - W Przybycień
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - I Zamojska
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - B Kołodziejczyk
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - J Walocha
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - M Koziej
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
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22
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Bonczar M, Ostrowski P, Dziedzic M, Stachera B, Michalczak M, Canon R, Przybycień W, Wojciechowski W, Wysiadecki G, Walocha J, Koziej M. The costocervical trunk: A Detailed Review. Clin Anat 2022; 35:1130-1137. [PMID: 35796160 DOI: 10.1002/ca.23929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The number of studies on the anatomy of the costocervical trunk (CCT) is scarce, and the actual prevalence of this structure is unknown. Therefore, the authors of the present study would like to propose a set of four types of CCT, which were created based on observations of computed tomography angiographies (75 CCTs). MATERIALS AND METHODS A retrospective study was conducted to establish variations and the morphometric properties of the CCT. The results of 55 consecutive patients who underwent neck and thoracic computed tomography angiography (CTA) were analyzed in March 2022. RESULTS The analysis was performed on a total of 75 CCTs. Of these, 32 were from women (42.7%) and 43 were from men (57.3%). Branching variations of each CCT were thoroughly analyzed. A classification of the branching pattern of the CCTs was made and consisted of 4 types. CONCLUSION In the present study, the variety of branching and morphology of CCT was analyzed, proposing its novel classification based on the four most frequently observed types. Type 1 was the most prevalent (76.1%), having a similar origin and branching pattern as described in the major anatomical books. CCT was found to be absent in 23.94% of the cases, making it a somewhat less consistent branch of the SA. Understanding the variability of the anatomy of the CCT can be a great tool for physicians performing endovascular procedures in the cervical region. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Michał Bonczar
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Patryk Ostrowski
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Martyna Dziedzic
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Bartłomiej Stachera
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz Michalczak
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Rinoa Canon
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Wojciech Przybycień
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Wadim Wojciechowski
- Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | | | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
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23
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Affiliation(s)
- David V Feliciano
- Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
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24
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Ferris S, Chan M, Miller G. Incidence of brachial plexus injury with concurrent subclavian or axillary vascular injury and its influence on reconstruction. ANZ J Surg 2022; 92:1196-1198. [PMID: 35229434 DOI: 10.1111/ans.17558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/23/2022] [Accepted: 02/06/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Brachial plexus reconstruction with free functional muscle transfers (FFMT) has become a reliable tool in the armamentarium of brachial plexus surgeon (Potter and Ferris, The Journal of hand surgery, European volume, 2017, 42,693-9). The successful execution of performing FFMT relies on favourable motor nerves for coaptation and appropriate vessels for microvascular anastomoses. Due to shared traumatic aetiology, subclavian and axillary vascular injury (SAVI) can coexist with the brachial plexus palsy and may pose a surgical dilemma with such FFMT execution. METHOD We performed a retrospective study of 100 consecutive patients who presented to our hospital with brachial plexus injury over a 10-year period. Patient records were reviewed for concomitant SAVI and subsequent treatment that was required for both vascular (SAVI) and brachial plexus injuries (BPI). RESULTS Concomitant BPI and SAVI occurred in 27% of patients. Open injuries predicted significantly higher rates of SAVI as well as complete plexus palsy. Complete plexus palsy was associated at a higher rate in the SAVI group compared to the non-SAVI group. CONCLUSION Coexistence of SAVI and BPI is frequent. Complete plexus palsy and SAVI are more common in open injuries in this study. Complete plexus palsy is the most common indication for FFMT in BPI. Surgical execution of FFMT is more challenging in the setting of previous SAVI and requires careful consideration of the microsurgical plan. We recommend that all patients with previous SAVI or potential need for FFMT in this setting undergo vascular imaging at the time of acute injury and prior to any free flap reconstructive procedures.
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Affiliation(s)
- Scott Ferris
- Plastic, Reconstructive & Hand Surgery Department, Alfred Hospital, Melbourne, Victoria, Australia
| | - Marion Chan
- Plastic, Reconstructive & Hand Surgery Department, Alfred Hospital, Melbourne, Victoria, Australia
| | - George Miller
- Plastic, Reconstructive & Hand Surgery Department, Alfred Hospital, Melbourne, Victoria, Australia
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25
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Craiu DC, Bastian AE, Zurac SA, Băilă SL, Croitoru M, Craiu M, Diaconu R, Vinţan MA, Bârcă DG. Brachial and subclavian arteries aneurysms due to tuberous sclerosis complex mechanisms - case report and literature review. Rom J Morphol Embryol 2022; 63:181-189. [PMID: 36074682 PMCID: PMC9593110 DOI: 10.47162/rjme.63.1.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/26/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Tuberous sclerosis complex (TSC) is a rare autosomal dominant condition characterized by cutaneous, cerebral, and other multiorgan involvement. Aneurysms due to TSC pathogenic mechanism are rarely present, mainly aortic, renal, or intracranial and very few associated with peripheral circulation. A TSC patient, aged 31 years, who developed brachial and subclavian arteries aneurysms is presented. The question of a random association of the aneurysms with TSC versus aneurysms within pathogenic released mammalian target of rapamycin (mTOR) pathway effect was raised. CASE PRESENTATION Patient's file, available from the age of six months, was analyzed for demonstration of the TSC diagnosis. Patient was examined, and cerebral magnetic resonance imaging (MRI) was repeated. Surgery and angiographic reports and images were reviewed. Pathology of the aneurysmal wall available from surgery was reexamined and special stainings and immunohistochemistry markers were applied. Genetic characterization of the patient was performed. Definite TSC was diagnosed based on major criteria [ungual fibromas, shagreen patch, cortical tubers, subependymal nodules (SENs), subependymal giant cell astrocytoma (SEGA)], minor criteria (confetti skin lesions, dental enamel pits, gingival fibromas), genetic result showing heterozygous variant in exon 8 of TSC1 gene (c.733C>T-p.Arg245*). Pathology analysis revealed markedly thickened aneurysmal wall due to smooth muscle cells (SMCs) proliferation in media and neoformation vessels with similar characteristics in the aneurysmal wall. DISCUSSIONS AND CONCLUSIONS This is a rare case with aneurysms related to TSC, with an exceptional peripheral localization. Pathology exam is the key investigation in demonstrating the TSC-related pathogenic mechanism. A literature review showed 73 TSC cases presenting aneurysms published until now.
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Affiliation(s)
- Dana Cristina Craiu
- Discipline of Pediatric Neurology II, Department of Clinical Neurosciences, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Clinic of Pediatric Neurology, Prof. Dr. Alexandru Obregia Clinical Psychiatric Hospital, Bucharest, Romania
| | - Alexandra Eugenia Bastian
- Discipline of Pathology, Department II, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Laboratory of Pathology, Colentina University Hospital, Bucharest, Romania
| | - Sabina Andrada Zurac
- Discipline of Pathology, Department II, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Laboratory of Pathology, Colentina University Hospital, Bucharest, Romania
| | - Sorin Liviu Băilă
- Vascular Surgery Group, Ponderas Academic Hospital, Bucharest, Romania
| | - Marian Croitoru
- Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
| | - Mihai Craiu
- Department of Pediatrics and Medical Genetics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Pediatric Clinic II, Alessandrescu–Rusescu National Institute, Bucharest, Romania
| | - Radu Diaconu
- Department of Pediatrics, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
- Department of Pediatrics, Filantropia Municipal Hospital, Craiova, Romania
| | - Mihaela-Adela Vinţan
- Department of Neuroscience, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Clinical Hospital for Children, Cluj-Napoca, Romania
| | - Diana Gabriela Bârcă
- Discipline of Pediatric Neurology II, Department of Clinical Neurosciences, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Clinic of Pediatric Neurology, Prof. Dr. Alexandru Obregia Clinical Psychiatric Hospital, Bucharest, Romania
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Nagatomi S, Ichihashi S, Kanamori D, Yamamoto H. Successful Sac Embolization to Eliminate a Type 2 Endoleak After Thoracic Endovascular Aortic Repair by Penetration of a Vascular Plug Implanted in a Left Subclavian Artery. J Endovasc Ther 2021; 29:835-838. [PMID: 34969293 DOI: 10.1177/15266028211067730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe a technique of vascular plug penetration by a guidewire with a heavy tip load for additional embolization of a type 2 endoleak after endovascular aortic aneurysm repair (EVAR). TECHNIQUE The technique of vascular plug penetration is effective for additional embolization of a type 2 endoleak, when large arteries such as left subclavian artery (LSA) or hypogastric artery remain patent even after the embolization of the vessel has been performed using a vascular plug and are responsible for the endoleak. A tapered guidewire with a heavy tip load enables the penetration of the disk of the plug, followed by introduction of a microcatheter into the endoleak nidus. In the presented case, the technique successfully eliminated a type 2 endoleak in a thoracic aortic aneurysm for which a patent LSA despite the embolization by a vascular plug was responsible. CONCLUSION The technique of vascular plug penetration allows an access to an endoleak cavity via a vascular plug placed in an aortic side branch for additional embolization of a type 2 endoleak after EVAR.
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Affiliation(s)
| | - Shigeo Ichihashi
- Department of Radiology, Nara Medical University, Kashihara, Japan
| | - Daigo Kanamori
- Department of Radiology, Sumitomo Hospital, Osaka, Japan
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27
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Parra MW, Ordoñez CA, Pino LF, Millán M, Caicedo Y, Buchelli VR, García A, González-Hadad A, Salcedo A, Serna JJ, Quintero L, Herrera MA, Hernández F, Rodríguez-Holguín F. Damage control surgery for thoracic outlet vascular injuries: the new resuscitative median sternotomy plus REBOA. Colomb Med (Cali) 2021; 52:e4054611. [PMID: 34908619 PMCID: PMC8634276 DOI: 10.25100/cm.v52i2.4611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 04/21/2021] [Accepted: 06/07/2021] [Indexed: 12/02/2022] Open
Abstract
Thoracic vascular trauma is associated with high mortality and is the second most common cause of death in patients with trauma following head injuries. Less than 25% of patients with a thoracic vascular injury arrive alive to the hospital and more than 50% die within the first 24 hours. Thoracic trauma with the involvement of the great vessels is a surgical challenge due to the complex and restricted anatomy of these structures and its association with adjacent organ damage. This article aims to delineate the experience obtained in the surgical management of thoracic vascular injuries via the creation of a practical algorithm that includes basic principles of damage control surgery. We have been able to show that the early application of a resuscitative median sternotomy together with a zone 1 resuscitative endovascular balloon occlusion of the aorta (REBOA) in hemodynamically unstable patients with thoracic outlet vascular injuries improves survival by providing rapid stabilization of central aortic pressure and serving as a bridge to hemorrhage control. Damage control surgery principles should also be implemented when indicated, followed by definitive repair once the correction of the lethal diamond has been achieved. To this end, we have developed a six-step management algorithm that illustrates the surgical care of patients with thoracic outlet vascular injuries according to the American Association of the Surgery of Trauma (AAST) classification.
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Affiliation(s)
- Michael W Parra
- Broward General Level I Trauma Center, Department of Trauma Critical Care, Fort Lauderdale, FL - USA
| | - Carlos A Ordoñez
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Luis Fernando Pino
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Mauricio Millán
- Universidad Icesi, Cali, Colombia.,Fundación Valle del Lili, Department of Surgery, Division of Transplant Surgery, Cali, Colombia
| | - Yaset Caicedo
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | | | - Alberto García
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Adolfo González-Hadad
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Centro Médico Imbanaco, Cali, Colombia
| | - Alexander Salcedo
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - José Julián Serna
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Laureano Quintero
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia.,Centro Médico Imbanaco, Cali, Colombia
| | - Mario Alain Herrera
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Fabian Hernández
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Fernando Rodríguez-Holguín
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
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Abstract
The definition of subclavian steal is subclavian artery occlusion or hemodynamically significant stenosis proximal to the origin of the vertebral artery that results in lower pressure in the distal subclavian artery. Although subclavian steal can often remain asymptomatic, if ignored, it can cause syncope or neurological deficits. Detailed routine evaluation of blood pressure and careful physical examination, simultaneously on both sides of patients at high vascular risk (such as those with hypertension, dyslipidemia, and diabetes), can assist in the early detection. Herein, we report the case of an 82-year-old male patient with steal syndrome, who had no subjective symptoms despite severe stenosis of the subclavian artery, with a marked left-right difference in blood pressure.
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Affiliation(s)
- Yu Amano
- Faculty of Medicine, Shimane University, Izumo, JPN
| | - Takashi Watari
- General Medicine Center, Shimane University Hospital, Izumo, JPN
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29
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Ahmed Z, Udongwo N, Albustani S, Taj S, Wiseman K, Alchalabi H, Hossain MA. Dysphagia Lusoria: A Little Known Cause of Chest Pain. Cureus 2021; 13:e20085. [PMID: 34993033 PMCID: PMC8719827 DOI: 10.7759/cureus.20085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 11/23/2022] Open
Abstract
Dysphagia lusoria is a congenital abnormality characterized by an aberrant right subclavian artery. It often presents as either an incidental finding on imaging or chronic dysphagia. We describe the case of a 66-year-old female who presented with severe chest pain, worse with swallowing, along with an ongoing globus sensation. She was found to have a negative cardiac workup for ischemia with a subsequent computed tomography angiogram (CTA) of the chest showing an abnormal right subclavian artery. We emphasize the unique diagnostic approach of this rare anatomical anomaly and its potential presentation that worsens with deglutition.
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Affiliation(s)
- Zaka Ahmed
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Ndausung Udongwo
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Safa Albustani
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Sobaan Taj
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Kyle Wiseman
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Halah Alchalabi
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Mohammad A Hossain
- Medicine, Hackensack Meridian School of Medicine, Nutley, USA
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
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30
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Cohen-Mussali S, Leon M, Ramírez-Cerda C, Cobos-Gonzalez E, Valdes-Flores J. Hybrid Procedure for Coexistence of Coarctation of the Aorta and Aberrant Right Subclavian Artery: A Case Report and Review of the Literature. Vasc Endovascular Surg 2021; 56:190-195. [PMID: 34569376 DOI: 10.1177/15385744211048309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Coarctation of the aorta (CoA) can either present alone as an isolated condition or in association with other aortic arch or cardiac anomalies. One percent of patients with CoA have concomitant an aberrant right subclavian artery (ARSA). Purpose: We report the case of a 35-year-old woman with uncontrolled hypertension who was found to have CoA and ARSA. Results: The patient was treated successfully using a hybrid procedure comprising ARSA ligation and subclavian to carotid transposition, followed by thoracic endovascular aortic repair. Conclusions: Patients with CoA should be carefully studied, considering the possible coexistence of other congenital aortic arch defects, such as ARSA. Hybrid repair is a safe and effective approach for this condition.
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Affiliation(s)
| | - Monica Leon
- 61188Centro Medico ABC, Ciudad de Mexico, Mexico
| | | | - Ernesto Cobos-Gonzalez
- 61188Centro Medico ABC, Ciudad de Mexico, Mexico.,Hospital Diomed, Ciudad de Mexico, Mexico
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31
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Shen H, Yun Y, Huang J, Zheng Z, Zhao D, Chen S, Zhang S, Wu Z, Zou C, Zhang H, Ma X. Surgical Intervention of a Rare Case of Complex Coarctation of Descending Aorta. Circ Cardiovasc Imaging 2021; 14:e013010. [PMID: 34445888 DOI: 10.1161/circimaging.121.013010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hechen Shen
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China (H.S., J.H., D.Z., S.C., S.Z., Z.W., C.Z., H.Z., X.M.)
| | - Yan Yun
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China (Y.Y.)
| | - Junjie Huang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China (H.S., J.H., D.Z., S.C., S.Z., Z.W., C.Z., H.Z., X.M.)
| | - Zheng Zheng
- Shandong Provincial Hospital affiliated to Shandong University and Shandong First Medical University, Jinan, China (Z.Z.)
| | - Diming Zhao
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China (H.S., J.H., D.Z., S.C., S.Z., Z.W., C.Z., H.Z., X.M.)
| | - Shanghao Chen
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China (H.S., J.H., D.Z., S.C., S.Z., Z.W., C.Z., H.Z., X.M.)
| | - Shijie Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China (H.S., J.H., D.Z., S.C., S.Z., Z.W., C.Z., H.Z., X.M.)
| | - Zezhong Wu
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China (H.S., J.H., D.Z., S.C., S.Z., Z.W., C.Z., H.Z., X.M.)
| | - Chengwei Zou
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China (H.S., J.H., D.Z., S.C., S.Z., Z.W., C.Z., H.Z., X.M.)
| | - Haizhou Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China (H.S., J.H., D.Z., S.C., S.Z., Z.W., C.Z., H.Z., X.M.)
| | - Xiaochun Ma
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China (H.S., J.H., D.Z., S.C., S.Z., Z.W., C.Z., H.Z., X.M.)
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32
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Hellou E, Roguin A. Occluded Left Subclavian With Unusual Collateral Blood Supply From the Right Vertebral Artery. JACC Cardiovasc Interv 2021; 14:e219-e220. [PMID: 34332940 DOI: 10.1016/j.jcin.2021.04.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/20/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Elias Hellou
- Cardiology Department, Hillel Yaffe Medical Center, Hadera, Israel; Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Ariel Roguin
- Cardiology Department, Hillel Yaffe Medical Center, Hadera, Israel; Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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33
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Bashir M, Bailey D, Jones WD, White RD, Williams IM. The fate of the left subclavian artery in TEVAR for aortic arch pathology. J Card Surg 2021; 36:3547-3553. [PMID: 34309881 DOI: 10.1111/jocs.15831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM OF STUDY The origin of the vertebral artery (VA) from the left subclavian (LSA) is variable and must be considered when proximal ligation or embolization is performed post thoracic endovascular aortic repair (TEVAR) and extra-anatomical bypass (EAB). A retrospective study was conducted to understand the patency of the LSA and VAs after TEVAR and the relationship of the EAB to the LSA. METHODS Fifty-six patients underwent TEVAR where the LSA origin was occluded. A comparison was performed between the length of the proximal LSA from the arch of the aorta to the origin of the VA. Patient outcomes included posterior or anterior circulation cerebrovascular accident, spinal cord ischemia (SCI), and symptoms and signs of left arm ischemia (LAI). Thirty one underwent EAB with 8 undergoing occlusion of the LSA proximal to the origin of the left VA. A further 25 underwent TEVAR with no EAB performed. The mean (standard deviation) of origin of the VA from the origin at the arch was 37.0 (12.9) mm compared to 34.0 (13.7) mm in those where no bypass was performed (p 0.45). Four patients underwent intraluminal plug occlusion and four had external ligation of the proximal LSA in those undergoing EAB. CONCLUSIONS Careful evaluation of the LSA is needed when planning TEVAR as occlusion techniques may be dependent on a minimum length of the VA from the aortic arch. The mean length of the VA from the aorta has high heterogeneity which may dictate the optimum occlusion method for LSA.
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Affiliation(s)
- Mohamad Bashir
- Department of Vascular Surgery, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Damian Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - William D Jones
- Department of Vascular Surgery, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Richard D White
- Department of Vascular Surgery, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Ian M Williams
- Department of Vascular Surgery, University Hospital of Wales, Heath Park, Cardiff, UK
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34
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Abstract
Mortality from penetrating traumas involving the subclavian vessels can be as high as 60% in pre-hospital settings. Operating room mortality is in the range of 5-30%. This paper presents a case in which a strategy for damage control was employed for a patient with an injury to the origin of the left subclavian artery, using subclavian ligation, with no need for any other intervention, and maintaining viability of the left upper limb via collateral circulation. The authors also review surgical approaches and treatment strategies with a focus on damage control in subclavian vessel injuries.
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Affiliation(s)
- Adenauer Marinho de Oliveira Góes
- Cirurgia Vascular, Hospital Metropolitano de Urgência e Emergência - HMUE, Ananindeua, PA, Brasil.,Faculdade de Medicina, Universidade Federal do Pará - UFPA, Belém, PA, Brasil
| | - Mariana Pereira Maurity
- Cirurgia Geral, Hospital Metropolitano de Urgência e Emergência - HMUE, Ananindeua, PA, Brasil
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35
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Benoit M, Trefois C, Gerber B, Scavee C, Marchandise S. Ventricular lead malposition after TAVR causing ischaemic stroke. Acta Cardiol 2021; 76:564-566. [PMID: 33467976 DOI: 10.1080/00015385.2020.1858249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Martin Benoit
- Department of Cardiology, Cliniques Universitaires UCL Mont-Godinne, Yvoir, Belgium
| | - Cédric Trefois
- Department of Radiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Bernhard Gerber
- Department of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Christophe Scavee
- Department of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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36
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Ben Mrad I, Ben Fatma L, Ben Mrad M, Miri R, Mleyhi S, Mami I, Zairi I, Denguir R. Endovascular Management of a Subclavian Arterial Injury During Central Venous Catheter Placement for Hemodialysis. Open Access Emerg Med 2021; 13:273-277. [PMID: 34194247 PMCID: PMC8238546 DOI: 10.2147/oaem.s308233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/03/2021] [Indexed: 11/23/2022] Open
Abstract
Subclavian artery injuries after central venous catheter placement constitute a rare but potentially fatal complication. The surgical repair of a subclavian artery trauma is a real challenge, associated with a high rate of morbidity and mortality. The role of endovascular treatment for vascular trauma, including injury to the subclavian artery, continues to evolve. In this manuscript, we report the case of an urgent endovascular repair by a covered stent graft of a subclavian artery perforation following the placement of a central venous catheter for dialysis in a 52-year-old patient, having a chronic kidney failure stage 5, with multiple comorbidities. The present case suggests that attention needs to be paid to preventing iatrogenic arterial cannulation during central vein catheterization to avoid potentially devastating complications. Endovascular treatment using a covered stent should be attempted as a first-line therapeutic option.
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Affiliation(s)
| | | | - Melek Ben Mrad
- Cardiovascular Surgery Department, Rabta Hospital, Tunis, Tunisia
| | - Rim Miri
- Cardiovascular Surgery Department, Rabta Hospital, Tunis, Tunisia
| | - Sobhy Mleyhi
- Cardiovascular Surgery Department, Rabta Hospital, Tunis, Tunisia
| | - Ikram Mami
- Nephrology Department, Rabta Hospital, Tunis, Tunisia
| | - Ihsen Zairi
- Cardiology Department, Habib Thameur Hospital, Tunis, Tunisia
| | - Raouf Denguir
- Cardiovascular Surgery Department, Rabta Hospital, Tunis, Tunisia
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37
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Milagres VAMV, Avellar RLDS, Silva APP, Pires PJ, Pinto DM. Treatment of upper limb arterial occlusion caused by a cervical rib. J Vasc Bras 2021; 20:e20200193. [PMID: 34211537 PMCID: PMC8218826 DOI: 10.1590/1677-5449.200193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The cervical rib syndrome occurs when the interscalene triangle is occupied by a cervical rib, displacing the brachial plexus and the subclavian artery forward, which can cause pain and muscle spasms. The objective of this study is to discuss diagnosis of the cervical rib syndrome and treatment possibilities. This therapeutic challenge describes clinical and surgical management of a 37-year-old female patient with upper limb arterial occlusion caused by a cervical rib.
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38
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Chakravarthy M, Prabhakumar D, Shivalingappa B, Rao S, Padgaonkar S, Hosur R, Harivelam C, Jawali V. Routine preoperative doppler ultrasound examination of arterial system in patients undergoing cardiac surgery is beneficial: A retrospective study. Ann Card Anaesth 2021; 23:298-301. [PMID: 32687086 PMCID: PMC7559945 DOI: 10.4103/aca.aca_18_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Presence of peripheral vascular disease enhances surgical risk in cardiac surgical patients. Prior knowledge of peripheral arterial disease may help the physician make changes in the monitoring and cardiopulmonary bypass cannulation plans. It is claimed that the incidence of peripheral vascular disease in cardiac surgical patients ranges from 11 to 30%. Aims: This study was conducted to understand the characteristics of peripheral vascular disease and their implication on cardiac surgery. Settings and Design: This was a prospective study undertaken in a tertiary referral hospital. Materials and Methods: All adult patients who underwent cardiac surgery during the period of six months were included. A Doppler examination of the neck, upper limb, abdomen and lower limb was carried out by our inhouse radiologist. The incidence of peripheral vascular disease, the implication on invasive pressure monitoring site and cannulation for cardiopulmonary bypass or intraaortic balloon pump or extracorporeal membrane oxygenation were made note of. Results: During the said period, six hundred twenty eight patients underwent cardiac surgery, of whom five hundred and sixty-one patients who underwent CABG surgery. All these were subjected to Doppler examination. We observed peripheral arterial disease in 105 patients (20%). In general men suffered from PAD more often than women. Monitoring site of invasive arterial pressure, the choice of beating heart surgery, insertion of intraaortic balloon pump, femoral arterial route for cardiopulmonary bypass were some of the decision that were altered. Conclusions: Performing Doppler examination in cardiac surgical patients may yield important data that might prevent complications and support patient safety.
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Affiliation(s)
- Murali Chakravarthy
- Department of Anesthesia, Critical Care, and Pain Relief, Fortis Hospital, Bengaluru, Karnataka, India
| | - Dattatreya Prabhakumar
- Department of Anesthesia, Critical Care, and Pain Relief, Fortis Hospital, Bengaluru, Karnataka, India
| | - Benak Shivalingappa
- Department of Anesthesia, Critical Care, and Pain Relief, Fortis Hospital, Bengaluru, Karnataka, India
| | - Sonali Rao
- Department of Anesthesia, Critical Care, and Pain Relief, Fortis Hospital, Bengaluru, Karnataka, India
| | - Sumant Padgaonkar
- Department of Anesthesia, Critical Care, and Pain Relief, Fortis Hospital, Bengaluru, Karnataka, India
| | - Rajathadri Hosur
- Department of Anesthesia, Critical Care, and Pain Relief, Fortis Hospital, Bengaluru, Karnataka, India
| | - Chidananda Harivelam
- Department of Anesthesia, Critical Care, and Pain Relief, Fortis Hospital, Bengaluru, Karnataka, India
| | - Vivek Jawali
- Department of Cardiovascular Surgery, Fortis Hospital, Bengaluru, Karnataka, India
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Patel A, Velamakanni SM, Parikh RM, Pandya S, Patel T. The Role of Echocardiography in Evaluation of Takayasu's Arteritis: A Report of Two Cases. Cureus 2021; 13:e15286. [PMID: 34221751 PMCID: PMC8237925 DOI: 10.7759/cureus.15286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Takayasu's arteritis (TA) is a large-vessel chronic inflammatory vasculitis that leads to thrombotic vascular occlusion. This can lead to varied presentations including limb claudication, ischemic stroke, hypertension, and heart failure. Although contrast computed tomography angiography is the main modality for imaging of the aorta and its branches, transthoracic echocardiography can be an easy-to-access, point-of-care, initial screening tool for evaluating the aorta and other cardiac structures. We present echocardiographic images from two cases that demonstrate the important cardiac structural and vascular afflictions of TA.
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Affiliation(s)
- Aman Patel
- Cardiology, Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, IND
| | | | - Rinal M Parikh
- Internal Medicine, Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, IND
| | - Sapan Pandya
- Rheumatology, Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, IND
| | - Tejas Patel
- Cardiology, Apex Heart Institute, Ahmedabad, IND.,Cardiology, Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, IND
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40
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da Silva ER, Dalio MB, Santarosa MB, Oliveira TF, Ribeiro MS, Joviliano EE. Surgical treatment of cervical rib-associated arterial thoracic outlet syndrome. J Vasc Bras 2021; 20:e20200106. [PMID: 34093679 PMCID: PMC8147708 DOI: 10.1590/1677-5449.200106_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The arterial form of thoracic outlet syndrome is rare and is associated with anatomic anomalies, generally a cervical rib. It has a varied range of manifestations. The aim of this article is to describe two cases with different clinical presentations: microembolization and aneurysm. A cervical rib was present in both cases. Diagnosis was made on the basis of history, physical examination, postural maneuvers, and X-rays. Computed tomography angiography provided the anatomic detail necessary to plan surgery. Surgical treatment was performed via supraclavicular access, successfully, in both cases.
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Affiliation(s)
- Elpidio Ribeiro da Silva
- Universidade de São Paulo - USP, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Divisão de Cirurgia Vascular e Endovascular, Ribeirão Preto, SP, Brasil
| | - Marcelo Bellini Dalio
- Universidade de São Paulo - USP, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Divisão de Cirurgia Vascular e Endovascular, Ribeirão Preto, SP, Brasil
| | - Marco Bianco Santarosa
- Universidade de São Paulo - USP, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Divisão de Cirurgia Vascular e Endovascular, Ribeirão Preto, SP, Brasil
| | - Tércio Ferreira Oliveira
- Universidade de São Paulo - USP, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Divisão de Cirurgia Vascular e Endovascular, Ribeirão Preto, SP, Brasil
| | - Maurício Serra Ribeiro
- Universidade de São Paulo - USP, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Divisão de Cirurgia Vascular e Endovascular, Ribeirão Preto, SP, Brasil
| | - Edwaldo Edner Joviliano
- Universidade de São Paulo - USP, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Divisão de Cirurgia Vascular e Endovascular, Ribeirão Preto, SP, Brasil
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41
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İşcan HZ, Ünal EU. Surgeon-modified fenestrated stent graft deployment in type B aortic dissection. Turk Gogus Kalp Damar Cerrahisi Derg 2021; 29:285-9. [PMID: 34104528 DOI: 10.5606/tgkdc.dergisi.2021.20641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 10/07/2020] [Indexed: 11/21/2022]
Abstract
The treatment of aortic dissections and aneurysms may be challenging for vascular surgeons. Currently, thoracic endovascular aortic repair is usually the first treatment option for descending aortic pathologies. Left subclavian artery coverage during this procedure is often required to achieve a sufficient proximal landing zone. Most surgeons agree that the left subclavian artery can be selectively covered, but revascularization is preferred to reduce the risk of neurological or ischemic complications. The chimney method, hybrid operations with extra-anatomic bypass, back table or in situ fenestrations are assistive techniques in this procedure. Herein, we present a surgeon-modified fenestrated stent graft for a type B aortic dissection patient.
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42
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Mitani Y, Kobayashi Z, Hattori E, Numasawa Y, Ishihara S, Tomimitsu H, Shintani S. Successful treatment of ischemic stroke associated with brachiocephalic artery stenosis using alteplase. J Rural Med 2021; 16:123-125. [PMID: 33833840 PMCID: PMC8016668 DOI: 10.2185/jrm.2020-064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/05/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction: Brachiocephalic artery stenosis rarely causes right
hemispheric infarction with associated left hemiparesis. To date, there have been no
reported cases of stroke associated with brachiocephalic artery stenosis that were
successfully treated with recombinant tissue-type plasminogen activator (rt-PA),
alteplase. Case Report: An 80-year-old woman presented with left hemiparesis. Brain
computed tomography showed no hemorrhage, and computed tomography angiography demonstrated
brachiocephalic artery stenosis. Alteplase was administered based on a diagnosis of
ischemic stroke. Brain magnetic resonance imaging showed multiple acute infarctions.
Thereafter, the blood pressure of the right arm was found to be lower than that of the
left arm. The patient’s neurological deficits gradually improved; she was eventually able
to walk again and was thus discharged home. Conclusion: While the combination of left hemiparesis and a decrease in
blood pressure in the right arm are well known in patients with stroke associated with
Stanford type A aortic dissections, it may also occur in patients with stroke due to
brachiocephalic artery stenosis. Unlike stroke associated with Stanford type A aortic
dissections, stroke due to brachiocephalic artery stenosis may be treated with
alteplase.
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Affiliation(s)
- Yuta Mitani
- Department of Neurology, JA Toride Medical Center, Japan
| | - Zen Kobayashi
- Department of Neurology, JA Toride Medical Center, Japan
| | - Eijiro Hattori
- Department of Cardiology, JA Toride Medical Center, Japan
| | - Yoshiyuki Numasawa
- Department of Internal Medicine, New Tokyo Hospital, Japan.,Aozora Clinic, Japan
| | | | | | - Shuzo Shintani
- Department of Neurology, JA Toride Medical Center, Japan
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43
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Gordeev ML, Uspenskiĭ VE, Rubinchik VE, Kotin AN, Skripnik AI, Zverev DA. [Removal of ascending aortic dissection and residual blood flow after transcatheter isolation of descending aortic dissection]. Angiol Sosud Khir 2021; 27:65-71. [PMID: 33825730 DOI: 10.33529/angio2021111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Presented herein is a clinical case report concerning successful simultaneous surgical treatment of a female patient with a complication after transcatheter treatment for chronic dissection of the descending portion of the thoracic aorta. The woman was subjected to elective transcatheter isolation of chronic dissection of the descending thoracic aorta using a stent graft with complete coverage of the zone of the origin of the left subclavian artery. Repeat control imaging studies several months after the intervention revealed residual blood flow through the false channel, directed retrogradely from the distal edge of the stent graft to the left subclavian artery. Besides, the patient was also found to have local dissection of the distal part of the ascending aorta (zone 0). An operative intervention was performed: sternotomy, prosthetic repair of the ascending portion of the aorta and part of the aortic arch, as well as transposition of the left subclavian artery to the left common carotid artery. The control imaging studies confirmed radical removal of the false aneurysm of the ascending aorta and the presence of total thrombosis of the false channel at the level of the stent graft.
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Affiliation(s)
- M L Gordeev
- Scientific Research Laboratory of Surgery for Cardiac Defects and Ischaemic Heart Disease, National Medical Research Centre named after V.A. Almazov under the RF Ministry of Public Health, Saint Petersburg, Russia
| | - V E Uspenskiĭ
- Scientific Research Laboratory of Surgery for Cardiac Defects and Ischaemic Heart Disease, National Medical Research Centre named after V.A. Almazov under the RF Ministry of Public Health, Saint Petersburg, Russia
| | - V E Rubinchik
- Scientific Research Laboratory of Surgery for Cardiac Defects and Ischaemic Heart Disease, National Medical Research Centre named after V.A. Almazov under the RF Ministry of Public Health, Saint Petersburg, Russia
| | - A N Kotin
- Scientific Research Laboratory of Surgery for Cardiac Defects and Ischaemic Heart Disease, National Medical Research Centre named after V.A. Almazov under the RF Ministry of Public Health, Saint Petersburg, Russia
| | - A Iu Skripnik
- Scientific Research Laboratory of Surgery for Cardiac Defects and Ischaemic Heart Disease, National Medical Research Centre named after V.A. Almazov under the RF Ministry of Public Health, Saint Petersburg, Russia
| | - D A Zverev
- Scientific Research Laboratory of Surgery for Cardiac Defects and Ischaemic Heart Disease, National Medical Research Centre named after V.A. Almazov under the RF Ministry of Public Health, Saint Petersburg, Russia
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44
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Sasson M, Montorfano L, Bordes SJ, Sarmiento Cobos M, Grove M. Subclavian Artery Injury Following Central Venous Catheter Placement. Cureus 2021; 13:e14287. [PMID: 33968501 PMCID: PMC8096622 DOI: 10.7759/cureus.14287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2021] [Indexed: 01/23/2023] Open
Abstract
Mechanical complications following central venous catheterization are not uncommon. We discuss a case of iatrogenic intra-arterial central venous catheter placement requiring neck exploration in a 93-year-old woman. The catheter was inadvertently passed through the jugular vein and into the right subclavian artery by a junior surgical resident. Adequate technique and supervision, ultrasound guidance, and immediate diagnostic workup in the event of suspected arterial injury are factors necessary for physicians to minimize complications and provide safe medical treatment.
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Affiliation(s)
- Morris Sasson
- Vascular Surgery, Cleveland Clinic Florida, Weston, USA
| | | | - Stephen J Bordes
- Surgical Anatomy, Tulane University School of Medicine, New Orleans, USA
| | | | - Mark Grove
- Vascular Surgery, Cleveland Clinic Florida, Weston, USA
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45
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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46
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Affiliation(s)
- Sayuri P Jinadasa
- Shock Trauma Center / Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Michael R Hall
- Shock Trauma Center / Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - David V Feliciano
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
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47
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Li N, Dierks G, Vervaeke HE, Jumonville A, Kaye AD, Myrcik D, Paladini A, Varrassi G, Viswanath O, Urits I. Thoracic Outlet Syndrome: A Narrative Review. J Clin Med 2021; 10:jcm10050962. [PMID: 33804565 PMCID: PMC7957681 DOI: 10.3390/jcm10050962] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/16/2021] [Accepted: 02/25/2021] [Indexed: 01/08/2023] Open
Abstract
Thoracic outlet syndrome comprises a group of disorders that result in compression of the brachial plexus and subclavian vessels exiting the thoracic outlet. Symptoms include pain, paresthesia, pallor, and weakness depending upon the compromised structures. While consensus in diagnostic criteria has not yet been established, a thorough patient history, physical exam, and appropriate imaging studies are helpful in diagnosis. General first-line therapy for thoracic outlet syndrome is a conservative treatment, and may include physical therapy, lifestyle modifications, NSAIDs, and injection therapy of botulinum toxin A or steroids. Patients who have failed conservative therapy are considered for surgical decompression. This article aims to review the epidemiology, etiology, relevant anatomy, clinical presentations, diagnosis, and management of thoracic outlet syndrome.
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Affiliation(s)
- Nathan Li
- Medical College of Wisconsin–Milwaukee, Milwaukee, WI 53233, USA;
| | - Gregor Dierks
- Louisiana State University Health Sciences Center–Shreveport, Shreveport, LA 71106, USA; (G.D.); (H.E.V.); (A.J.)
| | - Hayley E. Vervaeke
- Louisiana State University Health Sciences Center–Shreveport, Shreveport, LA 71106, USA; (G.D.); (H.E.V.); (A.J.)
| | - Allison Jumonville
- Louisiana State University Health Sciences Center–Shreveport, Shreveport, LA 71106, USA; (G.D.); (H.E.V.); (A.J.)
| | - Alan D. Kaye
- Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA 71106, USA; (A.D.K.); (O.V.); (I.U.)
| | - Dariusz Myrcik
- Department of Internal Medicine, Medical University of Silesia, Katowice, 42-600 Bytom, Poland;
| | | | - Giustino Varrassi
- Paolo Procacci Foundation, Via Tacito 7, 00193 Roma, Italy
- Correspondence: ; Tel.: +39-348-606-8472
| | - Omar Viswanath
- Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA 71106, USA; (A.D.K.); (O.V.); (I.U.)
- Valley Anesthesiology and Pain Consultants–Envision Physician Services, Phoenix, AZ 85004, USA
- Department of Anesthesiology, University of Arizona, Phoenix, AZ 85004, USA
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE 68114, USA
| | - Ivan Urits
- Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA 71106, USA; (A.D.K.); (O.V.); (I.U.)
- Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA 02571, USA
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48
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Abdelhafeez AH, Mansfield S, Talbot L, Murphy AJ, Davidoff AM. Improving Exposure Using Thoracoscopy for Apical Thoracic Neuroblastoma Encasing the Subclavian Vessels. J Laparoendosc Adv Surg Tech A 2021; 31:589-593. [PMID: 33599543 DOI: 10.1089/lap.2020.0850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Posterolateral thoracotomy provides limited access to the thoracic apex that can result in poor visualization of subclavian vessels, their branches, and the brachial plexus. A thoracoscopic approach may overcome these limitations. Purpose: We report a thoracoscopic approach and associated technical challenges in resecting apical thoracic neuroblastoma encasing the subclavian artery. Methods: A single-institution retrospective chart review was performed (2018-2020) for patients undergoing thoracoscopic resection of apical neuroblastoma encasing the subclavian artery. Patient demographics, imaging, and hospital course were reviewed. Operative video recordings were assessed for exposure quality, technical challenges, and percentage of tumor resection. Patients were placed laterally, with three 5-mm ports triangulated to the apex. Dissection started at the tumor edge and followed along the vessel and branches. Results: Four patients (median age 2.7 years) underwent thoracoscopic apical neuroblastoma resection. Median length of stay was 2.5 days. One low-risk patient underwent resection for tumor growth during observation. One intermediate and 2 high-risk patients received neoadjuvant chemotherapy. Two patients continued having persistent vascular encasement, whereas in 1 patient the mass decreased in size and only abutted the subclavian and vertebral arteries. In 1 patient, tumor involved the brachial plexus, which was freed and preserved thoracoscopically. All cases had substantial tumor-feeding vessels branching from the subclavian artery. There was one conversion to open thoracotomy due to dense tumor adherence to the subclavian artery and vein. More than 95% resection was achieved in all cases. All patients had baseline Horner syndrome. No complications were reported. Conclusion: The thoracoscopic approach for resecting apical neuroblastoma provides optimal exposure and safe access in selected patients.
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Affiliation(s)
- Abdelhafeez H Abdelhafeez
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, USA.,Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Sciences Center, Memphis, USA
| | - Sara Mansfield
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, USA
| | - Lindsay Talbot
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, USA.,Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Sciences Center, Memphis, USA
| | - Andrew J Murphy
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, USA.,Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Sciences Center, Memphis, USA
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, USA.,Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Sciences Center, Memphis, USA
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49
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Kim S, Jeon KN, Bae K. Aberrant Left Subclavian Artery-Esophageal Fistula in a Patient with a Prolonged Use of Nasogastric Tube: A Case Report and Literature Review. Diagnostics (Basel) 2021; 11:diagnostics11020195. [PMID: 33525727 PMCID: PMC7911238 DOI: 10.3390/diagnostics11020195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 01/06/2023] Open
Abstract
Arterial-esophageal fistula is a rare but potentially fatal complication. Right aortic arch with aberrant left subclavian artery is a rare congenital vascular anomaly that can cause esophageal compression, particularly when the proximal portion of the aberrant subclavian artery forms a Kommerell's diverticulum. Prolonged use of a nasogastric tube can cause pressure necrosis of the esophagus. We report a patient with massive gastrointestinal bleeding secondary to aberrant left subclavian artery-esophageal fistula after a prolonged use of nasogastric tube. A high index of suspicion is essential for better prognosis when a patient with congenital aortic arch anomaly shows upper gastrointestinal hemorrhage.
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Affiliation(s)
- Sungbin Kim
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju 52727, Korea; (S.K.); (K.B.)
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon 51472, Korea
| | - Kyung Nyeo Jeon
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju 52727, Korea; (S.K.); (K.B.)
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon 51472, Korea
- Correspondence: ; Tel.: +82-55-214-3896
| | - Kyungsoo Bae
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju 52727, Korea; (S.K.); (K.B.)
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon 51472, Korea
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50
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Artico M, Santarelli MT, Stevanato G, Cirocchi R, D'Andrea V, Nicolai A, Cialone G, Monteleone G, Pindinello I, Taurone S. The role of congenital malformations of the thoracic egress in the development of the syndrome. Folia Morphol (Warsz) 2021; 81:117-123. [PMID: 33438186 DOI: 10.5603/fm.a2020.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 11/25/2022]
Abstract
Thoracic Outlet Syndrome (TOS) represents a clinical condition caused by compression of the neurovascular structures that cross the thoracic outlet. TOS can be classified in: 1) NTOS (neurogenic TOS), 2) VTOS (venous TOS), 3) ATOS (arterial TOS). Many different causes can determine the Syndrome: Congenital Malformations, Traumas, and Functional Impairments. This manuscript reviews how the congenital malformations play an important role in adult age; however, TOS also affects patients of all ages. Radiological imaging like RX (radiography), MR (Magnetic Resonance) and CT (Computed Tomography) can provide useful information to assess TOS causes and decide a potential surgery.79% of the patientsincluded in the first two stages of NAV staging experienced excellent results with FKT; whereas patients included in the third and fourth stage of NAV staging were subject to surgery.The treatment of acute forms of TOS involves thrombolysis and anticoagulant therapy; surgery is appropriate for true neurogenic TOS, vascular TOS and in some cases when conservative treatment fails.
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Affiliation(s)
- M Artico
- Department of Sensory Organs, "Sapienza" University of Rome, Italy
| | - M T Santarelli
- Department of Sensory Organs, "Sapienza" University of Rome, Italy
| | - G Stevanato
- Neurosurgery Unit, Dell'Angelo Hospital, Mestre, Venice, Italy
| | - R Cirocchi
- Department of Surgical Sciences, University of Perugia, Italy
| | - V D'Andrea
- Department of Surgical Sciences, Sapienza University of Rome, Italy
| | - A Nicolai
- Department of Sensory Organs, "Sapienza" University of Rome, Italy
| | - G Cialone
- Unit of Radiology Regina Coeli, Rome, Italy
| | - G Monteleone
- Department of Biomedicine and Preventive Medicine, Tor Vergata University of Rome, Italy
| | - I Pindinello
- Department of Drug Chemistry and Technology, "Sapienza" University of Rome, Italy
| | - S Taurone
- Department of Sensory Organs, "Sapienza" University of Rome, Italy.
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