Subclavian Artery Aneurysm Research Articles

A large subclavian artery aneurysm inducing subclavian steal syndrome

Abstract Introduction: Subclavian steal syndrome (SSS) is primarily due to occlusion or stenosis of the innominate or proximal subclavian artery (SA). Subclavian artery aneurysm (SAA) is a rare type of peripheral vascular aneurysm. SAA inducing SSS is rare and only three case reports have been described in the literature. In our case, we document a large SAA located at the origin of vertebral artery that induced SSS. Patient concerns: A 65-year -old woman complained about repeated vertigo over the past 6 months. Her past history was significant for hypertension over 15 years and the blood pressure was not well controlled. Diagnosis: The computed tomography angiography showed a true SAA of size 4.2cmx3.8 cm. The transcranial Doppler showed reverse flow during systole and forward flow in diastole. Combined with the clinical manifestation and auxiliary examination, we diagnosed the patient with SSS induced by SAA. Interventions: The patient was treated with conventional blood pressure control and underwent aneurysmectomy and bypass surgery via right supraclavicular incision. Outcomes: After the surgery, the patient recovered successfully without any complications and the symptom of vertigo disappeared. During the 6-month follow-up period, her clinical condition remained stable. Conclusion: SAA causing SSS is very rare and is an often-overlooked cause of vertigo. Hence, when patients suffer from vertebrobasilar insufficiency such as vertigo or walking instability, examinations using ultrasonography, transcranial Doppler and even computed tomography angiography are necessary to exclude the complications caused by SAA and SSS.

Surgical treatment of subclavian artery aneurysms

Surgical treatment of subclavian artery aneurysms

Isolated True Subclavian Aneurysm without Aberrant Subclavian Artery or Coarctation of Descending Aorta

ObjectiveIsolated 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. MethodsThe 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. ResultsThe 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. ConclusionsThe 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.

Innominate Artery Ligation: A History From Mott to Matas

Innominate artery ligation emerged in the 19th century as an early operation for right subclavian aneurysm. Clinical outcomes were often dire, but undeterred surgeons believed that ligation represented an opportunity that outweighed the risks of nonoperative aneurysm management. Valentine Mott of New York performed the procedure in 1818; his patient died 26 days later. Variations on Mott's approach were undertaken 13 more times from 1822 to 1861 by surgeons in the United States and abroad, all of which proved fatal. Andrew Woods Smyth of New Orleans was the first to successfully control a subclavian artery aneurysm with innominate ligation in 1864. The Charity Hospital house surgeon used a series of ligations on the innominate, common carotid, vertebral, and internal mammary arteries to prevent collateral and recurrent blood flow to the aneurysmal sac. These physiologically-oriented operations kept Smyth's patient alive and functional for ten years. New Orleans became an internationally-recognized hub for advancements in aneurysm surgery. One of Smyth's students, Rudolph Matas, went on to revolutionize vascular surgery. Along his path to becoming the Father of modern vascular surgery, Matas documented his own performance of Smyth's operation at Charity 4 times over the course of his career. Although later supplanted by primary vascular anastomosis and grafting, the first successful innominate ligation was a collaborative effort between New York and New Orleans that served as a foundation for the development of modern aneurysm repair.

Operativni tretman aneurizme intratorakalnog segmenta leve potključne arterije u dva akta nakon prethodne koronarne hirurgije

Introduction: We present a case of a 70-year-old patient who underwent successful two-stage repair of an intrathoracic left subclavian artery aneurysm (SAA) and who had previously undergone CABG. Case presentation: The patient had previously undergone three-vessel coronary artery bypass graft (CABG) repair with the use of the left internal mammary artery (LIMA) to the left anterior descending artery (LAD). Percutaneous coronary intervention (PCI) was performed as a backup option in case of potential intra-operative LIMA-LAD bypass occlusion. Owing to the impossibility of hybrid repair due to a short proximal landing zone and aortic arch anomaly (bovine type), the vascular surgery review board decided to perform two-stage open surgery. Firstly, the patient underwent a left carotid-subclavian (C-S) bypass with the Dacron graft, with the application of the standard supraclavicular approach. After a few days, the second procedure, through the left posterolateral thoracotomy was performed. The left subclavian artery (SA) was ligated distally to the SAA but proximally to the origin of the LIMA. The distal aortic arch at the site of the left SAA was clamped partially and the aneurysm was excised. The defect of the aortic arch was sutured and reinforced with a felt patch. Postoperatively, the patient had a good recovery, without any signs of myocardial injury or any surgery-related issues. Conclusion: Careful planning and two-stage open surgical treatment of the left SAA, first with a left carotid-subclavian bypass, followed by aneurysm exclusion and suture of the outer aortic arch curvature may be a treatment option for patients not amenable to hybrid treatment.

Stent-graft removal from subclavian artery aneurysm followed by subclavian artery replacement in a patient with marfan syndrome and aortic aneurysm

<h3></h3> Представлен клинический случай повторного хирургического лечения аневризмы левой подключичной артерии у пациентки 34 лет с синдромом Марфана и мультифокальной аневризмой аорты. В 2006 г. были выполнены протезирование корня и восходящего отдела грудной аорты с реимплантацией аортального клапана (операция David I) и безимплантационная пластика митрального клапана. В 2012 г. больная перенесла протезирование торакоабдоминальной аорты по поводу впервые выявленной аневризмы IV типа. В 2016 г. при плановом обследовании выявлена аневризма левой подключичной артерии, выполнена имплантация стент-графта. В 2017 г. появились боли и онемение в левой верхней конечности. При КТ-ангиографии выявлен коллапс стент-графта с затеком контрастного вещества в аневризматический мешок и нарушением магистрального кровотока в соответствующей конечности. В плановом порядке удален стент-графт, выполнена резекция аневризмы левой подключичной артерии с ее протезированием. В течение 3 лет наблюдения протез подключичной артерии функционирует нормально, кровообращение в левой верхней конечности компенсировано.

A fatal case of right subclavian artery aneurysm due to takayasu's arteritis presenting as brachial plexopathy

A 36-year-old lady presented with insidious onset, gradually progressive neuropathic pain, sensory loss, and weakness of the right upper limb. Her brachial, ulnar, and radial pulses were not palpable on the right side and feeble on the left. She had an irregular, ill-localized 8 cm × 6 cm pulsatile swelling in the right supraclavicular region with thrill on palpation and bruit on auscultation. Motor system examination revealed grade 4 power with wasting of thenar muscles. Nerve conduction studies were suggestive of pan-brachial plexus involvement. Computed tomography angiogram images revealed thickening of the aortic arch, irregular narrowing of the descending aorta, and aneurysm of the right subclavian artery. She was diagnosed to be suffering from right brachial plexopathy due to compression by aneurysm of the right subclavian artery secondary to Takayasu's arteritis. The case is rare as no such presentation has been reported earlier.

Endovascular treatment with aortic endoprostheses for subclavian artery aneurysm secondary to late traumatic axillary-axillary arteriovenous fistula.

Traumatic arteriovenous fistulas (AVFs) involving the axillary and subclavian vessels are uncommon and account for 5 to 10% of all arterial traumas. The complex anatomy of this region makes treatment of this segment challenging. In this therapeutic challenge, we describe the case of a 73-year-old man, referred for progressive edema and ulceration involving the right upper limb and with a history of gunshot wound to the right infraclavicular region about 50 years previously. Angiotomography was performed and an axillary-axillary AVF was found, associated with tortuosity and aneurysmatic dilation of the subclavian artery downstream. He underwent endovascular intervention and a conical (monoiliac) 26 × 14 × 90 mm Braile® endoprosthesis was used in the aneurysmatic subclavian artery, posterior to the exit of the right vertebral artery and a 16 × 16 × 95mm Excluder® monoiliac endoprosthesis was placed overlapping the first prosthesis, showing a satisfactory result. Therefore, the possibility of successfully using aortic endoprostheses in an unusual and exceptional situation is described.

Symptomatic left subclavian artery aneurysm caused by thoracic outlet syndrome

Symptomatic left subclavian artery aneurysm caused by thoracic outlet syndrome

Long-term outcomes of endovascular treatment of isolated subclavian artery aneurysms.

The aim of the present study was to review our institutional experience of endovascular treatment for isolated subclavian artery aneurysms and evaluate the long-term outcomes. A retrospective review of all patients with isolated subclavian artery aneurysms who underwent endovascular treatment between March 2008 and March 2020 was performed. The demographics, aneurysmal characteristics, treatment strategies, and in-hospital and follow-up outcomes were recorded and then analyzed. From March 2008 to March 2020, 35 isolated subclavian artery aneurysms were endovascularly treated at our institution. Atherosclerosis was the most common cause of aneurysms in this series. Most aneurysms were intrathoracic (91.4%) and located at the right side (77.1%). There were 26 true aneurysms, seven pseudoaneurysms, and two ruptured isolated subclavian artery aneurysms. Five types of endovascular strategies were performed. Covered stent placement across the aneurysm was the most (54.3%) commonly used method. Technical success was achieved in all patients. The median postoperative in-hospital stay was 4.0 days (range, 1-15 days). One patient died after discharge but within 30 days of surgery due to myocardial infarction. The median follow-up time was 62.0 months (range, 3-132 months). No death, stroke, stent fractures, or severe upper limb ischemia developed during the follow-up period. The cumulative survival rate at five years was 97.1%. The overall complication rate was 25.7% and one-third of complications (8.6%) required reinterventions. Endovascular treatment for isolated subclavian artery aneurysms is safe, effective and technically achievable in most patients. Short- and long-term outcomes are promising. Reasonable and flexible use of covered stents can also get satisfactory outcomes in some complicated lesions such as isolated subclavian artery aneurysms located at the origin of the right subclavian artery, avoiding the huge surgical trauma caused by conventional open repair.

Acute kidney injury following percutaneous mechanical thrombectomy of subclavian artery stent graft thrombosis: a case report

BackgroundPercutaneous mechanical thrombectomy (PMT) is a well-established technique for treatment of acute arterial and venous thrombosis which inevitably leads to intravascular erythrocyte hemolysis, resulting in hemoglobinuria.Case presentationWe present a case of 66-year-old Caucasian female with subclavian artery aneurysm causing distal embolization and hand ischemia. The aneurysm was treated with stent graft, but with a subsequent graft thrombosis 3 months later. After graft recanalisation, AngioJet PMT was performed which resulted in dialysis-requiring acute kidney injury.ConslusionOnly several cases of acute kidney injury following AngioJet PMT have been published in literature. To our knowledge, this is the first reported case of dialysis-requiring AKI after PMT for peripheral arterial thrombosis. Until there is sufficient evidence and recommendation on preventing AKI in this setting, we believe that by being aware of the risk and by monitoring of patient, one might minimize the damage in case it occurs.

Subclavian artery aneurysms: pathogenesis, diagnosis, and therapeutic decision-making

The article deals with the relevant literature data concerning diagnosis and treatment of subclavian artery aneurysms. This nosological entity is relatively uncommon, however its importance for modern medicine should not be underestimated. Despite a low incidence of the pathology, it should be understood that the disease's course for the patient is associated with the development of severe complications which may lead to disability or even death. The development of complications is extremely difficult to predict and stratification of risks for such patients is too complicated. It is also known that the diagnosis of a subclavian artery aneurysm is frequently an accidental finding, since the pathology may for a long time proceed symptom-free. At the same time, the subclavian artery occupies the first place by the frequency of localization of upper-limb aneurysms, thus making this problem currently important. Besides, separate attention should be paid to modern methods of correction of this disease, since implementation of high-tech interventions into vascular surgery have significantly expanded the arsenal of the operating surgeon.

Hybrid Treatment of a True Right Subclavian Artery Aneurysm (SAA) involving the Vertebral Artery (VA) Using the Gore Viabahn Endoprosthesis.

Hybrid Treatment of a True Right Subclavian Artery Aneurysm (SAA) involving the Vertebral Artery (VA) Using the Gore Viabahn Endoprosthesis.

Early Experience and Outcomes of Fenestrated Endovascular Repair of Zone 1 and 2 Aortic Arch Pathologies – A Single Centre Review

Introduction - Surgical management of aortic arch pathologies is complex, and fenestrated aortic arch stenting has recently emerged as a less invasive and safer treatment alternative for pathologies involving the aortic arch. It is unfortunately only available in an elective setting and its long-term results are still unknown. We present our initial experience with fenestrated aortic arch repairs for various pathologies. Methods - All consecutive aortic arch pathology cases which underwent surgical repair in the Department of Vascular Surgery in a single tertiary institution were reviewed. To achieve optimal stent graft dimensions and implantations tactics, pre-operative planning included a computed tomography aortogram to assess anatomic suitability, and stent graft plans drawn up with the aid of the Aquarius iNtuition software (TeraRecon Inc., San Mateo, CA). Anatomic suitability was defined as having a proximal aortic sealing zone of less than 38mm in diameter and more than 20mm in length, the absence of an acutely curved aortic arch, absence of significant aortic tortuosity, and suitable sealing zones in target vessels. Results - From September 2015 to February 2018, five cases of fenestrated aortic arch stentings were performed. The patients were between 57 to 83 years old, all of whom were ASA class II or III. There were three male patients. Indications for surgery included three aortic arch aneurysms, one left subclavian artery aneurysm and one symptomatic type B aortic dissection. All cases were performed under general anaesthesia. In total, three patients had a scallop to the innominate artery, one had a scallop to the left common carotid artery, fenestrations were made to three left common carotid arteries and three left subclavian arteries. In two patients, a left carotid – subclavian bypass performed, and the left subclavian artery origin occluded with a vascular plug. Technical success was achieved in all five patients but one patient developed a right occipital infarct and acute myocardial infarction post procedure. The mean duration of surgery was 164 minutes and the mean length of stay was 4.2 days. The mean follow-up period was 14.4 months, and no endoleaks were detected on follow up imaging. Conclusion - In comparison to traditional open surgery, the use of fenestrated grafts in the aortic arch has emerged as a minimally invasive treatment option with relatively low morbidity and mortality. However, certain limitations still exist, and pre-operative planning is extremely important in ensuring technical and clinical success. Although this procedure appears feasible in the short term, long term results and durability are still being eagerly anticipated.

Right Aortic Arch: 10-Years Experience of Surgical Treatment

Introduction - The right aortic arch is rare congenital anomaly and is present in 0.05% to 0.1% of radiology series and in 0.04%>0.1% of autopsy series. Clinical or surgical studies in the adult have been limited to isolated cases or small series and have essentially focused on the diagnosis and approach to these lesions. The purpose of this study is to report our 10 years’ experience in surgical treatment of right aortic arch in patients with vascular ring, aortic coarcrtaion and thoracic aortic aneurysm. Methods - The clinical records of 16 patients who underwent operation for right aortic arch and its association with other congenital or acquired aortic disease between 2006 and 2017 were reviewed. The 7 male and 9 female patients ranged in age from 8 to 75 years (mean 30,2 ±20,3 years). Right aortic arch with mirror-image branching was diagnosed in 5 patients (31%); right aortic arch with aberrant left subclavian artery - in 11 cases (69%). Four patients (25%) had isolated vascular rings and symptoms attributable to tracheal or esophageal compression. Six patients (38%) had symptoms and signs of an associated anomaly, coarctation of the aorta, and in 5 cases (31%) thoracic aortic aneurysm was revealed (in 1 cases type B aortic dissection). One patient (6%) had signs of left subclavian artery aneurysm. A right thoracotomy was used when right aortic arch was associated with right sided descending thoracic aorta: in 5 patients with aortic coarctation and in 2 patients with aortic aneurysm. In 4 patients access to the vascular ring was obtained through a left thoracotomy, in all cases thoracic segment of left subclavian artery was translocated into left common carotid artery and ligamentum arteriosum was divided. The management of Kommerell’s aneurysms (in 3 patients) with and to end anastomosis were carried out. In 1 case of type B aortic dissection and in 1 case of postoperative false aneurysm of aortic isthmus aortic graft interposition was necessary. In aneurysm associated cases we advocate the use of distal circulatory support to reduce the incidence of paraplegia. A left subclavian-to-carotid transposition completed before the thoracic approach in 3 patients allowed to avoid the complexity of the intrathoracic procedure and to prevent spinal cord ischemia and subclavian steal syndrome. Results - There was no in-hospital mortality. The mean postoperative hospital stay was 10 days. No operations were necessary for recurrent or persistent compression of the trachea and esophagus. Two postoperative complications occurred: one patient had residual respiratory symptoms and one patient had asymptomatic thrombosis of translocated left subclavian artery without subclavian steal syndrome. At mean long term follow up time 3,75 years in 14 patients ( range 12 month to 10 years) no patient died and all patients were free of symptoms. Conclusion - Careful preoperative imaging and consideration of the individual anatomy in surgical planning are essential to achieve a successful outcome. Aortic coarcrtation or/and aneurysm associated with right sided aortic arch may be repaired through a right thoracotomy and distal circulatory support. A left subclavian-to-carotid transposition before thoracic repair allows decrease the risk of ischemic cerebral and spinal cord complications.

Determination of Clamp Site with Reference to a Cerebral Blood Flow Monitoring System in a Patient with a Right Subclavian Artery Aneurysm Complicated by Right Internal Carotid Artery Occlusion

Determination of Clamp Site with Reference to a Cerebral Blood Flow Monitoring System in a Patient with a Right Subclavian Artery Aneurysm Complicated by Right Internal Carotid Artery Occlusion

Stent-graft Treatment for Subclavian Artery Aneurysm: Report of a Case

Stent-graft Treatment for Subclavian Artery Aneurysm: Report of a Case

CAR 13. The “Sleeve-Shaping” Technique in the Treatment of Complex Peripheral Artery Aneurysms: Report of Two Cases

Peripheral artery aneurysms (PAAs) include popliteal, femoral, carotid, subclavian, upper limb, and visceral aneurysms, the incidence of which is much lower than that of abdominal aortic aneurysms. The treatment approach most recommended for PAAs is complete resection of the aneurysm sac followed by arterial reconstruction or endovascular repair with a stent graft. Here, we present a new technique, “sleeve shaping,” in the surgical treatment of two complex cases of extracranial carotid and subclavian artery aneurysms. Patients receiving surgery for PAAs using the sleeve-shaping technique in 2018 were included. Clinical characteristics, surgical procedure, and follow-up were analyzed. A 49-year-old and an 81-year-old man underwent surgery by the sleeve-shaping technique. Postoperative courses were unremarkable, and the patients are currently recovering well. In some conditions, the sleeve-shaping technique may be a good alternative for complex PAAs.

MISC 6. Endovascular Therapy for Subclavian Artery Aneurysm and its Long-term Outcomes

MISC 6. Endovascular Therapy for Subclavian Artery Aneurysm and its Long-term Outcomes

Two cases of asymptomatic axillary artery occlusion difficult to diagnose preoperatively: pitfalls and its solution in endovascular therapy when approaching from the upper extremity

BackgroundApproaching from the left brachial artery is an important access route in endovascular therapy for complicated aortic and peripheral artery cases.Here, we report two cases of a poor access route from the left brachial artery because of asymptomatic axillary artery occlusion (AAO), despite no preoperative upper arm blood pressure laterality, a normal ankle brachial pressure index, and absence of occlusion of the subclavian artery on CT scan.Case 1Seventy-six-year-old female. We planned endovascular aneurysm repair (EVAR) for para-renal abdominal aortic aneurysm using the snorkel technique in the renal artery, but we failed to pass through the left subclavian artery when approaching from the left brachial artery because of AAO.Case 2Seventy-three-year-old female. We planned zone 2 thoracic endovascular aneurysm repair (TEVAR) for thoracic aortic aneurysm and embolization of the left subclavian artery via the left brachial artery, but we failed to pass through the left subclavian artery because of AAO, and therefore, we simply covered the orifice of the left subclavian artery using a stent graft without embolization.ConclusionsThe presence of an asymptomatic AAO may alter the treatment plan but may be difficult to diagnose preoperatively. In those cases in which a brachial or radial artery access is planned, contrast medium should be injected from the contralateral upper extremity during preoperative enhanced CT since the absence of halation of the ipsilateral subclavian/axillary vein provides improved visualization of the AAO which may lead to a better preoperative strategy including the choice of the side of upper extremity access.