Subclavian Artery Aneurysm Research Articles

Endovascular treatment of ruptured subclavian artery aneurysm presented with hemoptysis

Ruptured subclavian artery aneurysm (SAA) is extremely rare and it can cause a life-threatening condition. We described an elderly patient with ruptured SAA who underwent endovascular treatment successfully. Our case showed that endovascular repair may be one of the options for the treatment of ruptured SAA when surgical repair is impossible or not indicated for its difficulty.<Learning objective: How to manage ruptured subclavian artery aneurysm by endovascular therapy.>

Polyarteritis Nodosa in Infancy – Generalized Vascular Problem Diagnosed after Initial Cardiac Manifestation in Emergency Cardiovascular Catheterization

Aim: Coronary artery diseases in children are uncommon, but in selected cases general vascular problems also affect the heart. Case: We present the case of 4-month old girl admitted to Pediatric Intensive Care Unit after the incident of cardiac arrest and ventricular tachycardia, who underwent diagnostic catheterization due to cardiac ischemia. Coronary angiography showed changes in coronary arteries in the form of disseminated aneurysms, mixed with severely stenosed segments. General angiography discovered also changes in the number of peripheral arteries, with the most significant right subclavian and left iliac artery aneurysms. Results: Upon angiographic images and a history of untreated infection, polyarteritis nodosa (PAN) was diagnosed, with an appropriate administration of intensive treatment.

Hybrid Repair of Proximal Subclavian Artery Aneurysm.

Conventional open repair for proximal subclavian artery aneurysms (SCAAs) requires cardiopulmonary bypass. However, patients with proximal SCAA can be treated with hybrid repair. Between 2007 and 2012, we performed hybrid repair to treat six consecutive patients with proximal SCAA (three left SCAAs, one right aberrant SCAA, two right SCAAs). Their median age was 73.5 [70-87] years, and the size of their aneurysm was 33.5 [30-45] mm. Thoracic endovascular aneurysm repair (TEVAR) only was used for one patient with left SCAA, TEVAR and supra-aortic bypass for two with left SCAA and one with right aberrant SCAA, and endovascular repair with reconstruction of the vertebral artery using the saphenous vein graft (SVG) for two with right SCAA. The follow-up duration was 3.7 [0.2-6.8] years. There was no 30-day mortality and only one early complication consisting of a minor stroke after TEVAR for shaggy aorta. Two late deaths occurred, one caused by cerebral infarction due to occlusion of SVG to the dominant vertebral artery 2 months after the operation and the other by aortic dissection 5 years postoperatively. Hybrid repair can be a less-invasive alternative for proximal SCAA. Revascularization of neck vessels and TEVAR should be performed very carefully to prevent neurologic complications.

Outcomes after false lumen embolization with covered stent devices in chronic dissection

Persistent retrograde false lumen perfusion is a common mode of failure after thoracic endovascular aortic repair (TEVAR) for chronic dissection. Objectives were to describe a novel endovascular approach for false lumen occlusion and assess outcomes. From 2009 to 2013, 21 patients (mean age, 64 ± 11 years) with chronic thoracoabdominal dissection underwent adjunctive false lumen embolization using covered stent devices for persistent retrograde perfusion. Eight patients had type B dissection, 13 had residual dissection after prior type A repair, and all were deemed high risk for open operation. False lumen embolization in 17 patients was an adjunct at the initial TEVAR or extension, including two as elephant trunk completion. In the other four, this was done as an isolated procedure, and three had previously undergone TEVAR sparing the celiac artery. Covered stent devices included iliac plugs in 18, nitinol embolization plugs in two, and occluded stent graft in one. More than one device was used in 15 patients. There was one hospital death due to left subclavian artery aneurysm rupture but no patient had stroke, paraplegia, myocardial infarction, or renal failure. Mean follow-up was 25 ± 19 months. During surveillance computed tomography imaging, false lumen thrombosis was noted in all patients, but four required further embolization because the thrombosis was incomplete. Mean maximum aortic diameter decreased from 64 ± 14 to 59 ± 15 mm. There was one late death from intracranial hemorrhage and no aortic ruptures. Adjunctive false lumen embolization with a covered stent device promotes thrombosis and remodeling after stent grafting the true lumen for chronic dissection. Further study of this strategy is warranted.

Open repair of adult aortic coarctation mostly by a resection and graft replacement technique

We report on our experience with treatment of adults requiring de novo or redo open aortic coarctation repair mostly by a resection and interposition graft technique. We retrospectively reviewed all patients older than 16 years requiring open repair of aortic coarctation. Indications for repair, operative details, and outcomes were analyzed. Between 1996 and 2011, we treated 29 adult aortic coarctation patients with open repair. The mean age was 42 years (range, 17-69 years), and there were 15 men. Nine patients had previous repair with recurrence; the remaining 20 had native coarctation. Thoracic aortic aneurysms were present in 22 patients (76%), ranging in size from 3.0 to 9.6 cm (mean, 4.8 cm). Four patients had intercostal artery aneurysms (range, 1.0-2.5 cm), four had left subclavian artery aneurysms, and four had ascending/arch aneurysms. The most common repair was resection of aortic coarctation with interposition graft replacement (93%). Two patients without aneurysm had bypasses from the proximal descending thoracic aorta to the infrarenal aorta without aortic resection. There was no in-hospital mortality, stroke, or paraplegia. Long-term survival was 89% during a median follow-up of 81 months (interquartile range, 47-118 months), with no patient requiring reoperation on the repaired segment. Open repair of native and recurrent adult aortic coarctation has acceptable morbidity and low mortality. Especially in patients with concomitant aneurysm, resection with interposition graft replacement provides a safe and durable repair option.

Subclavian fusiform aneurysm causing partial subclavian steal syndrome. Case report

We present a 55-year-old man with repeated transient symptoms of vertebrobasilar arterial pathology. Physical examination detected no signs that would indicate the stenosis of the proximal subclavian artery segment. Ultrasound detected hemodynamic disorder of right vertebral artery, which correspond to a partial subclavian steal syndrome. Angiography shows fusiform aneurysm of ipsilateral subclavian artery in which central part is the base of hypoplastic vertebral artery. In the literature are rare reports of cases of partial subclavian steal syndrome caused by aneurysmal expansion of subclavian artery.

A Case Report of Surgical Treatment of Symptomatic Aberrant Right Subclavian Artery Aneurysm (ARSA) at Bangkok Hospital Phuket, Thailand

Aberrant right subclavian artery (ARSA), also called arteria lusoria, is one of the most common intrathoracic arterial anomalies. Although most of the patients are asymptomatic, the retroesophageal and retrotracheal course of the lusorian artery&nbsp

Surgical and endovascular treatment of thoracic aortic dissection combined with aberrant right subclavian artery aneurysm

Aortic dissection combined with aberrant right subclavian artery (ARSA) is very rare. The endovascular treatment of aortic dissection is less invasive than conventional open‐heart surgery because of lower surgical risk and faster recovery. In the present work, the origin of ARSA was dilated, and the aorta was also dissected down to the abdominal aorta. The aortic true lumen became narrow, but the visceral arteries had good perfusion. The patient was treated on the entry of dissection with endovascular isolation and adjunctive surgical bypass after controlling blood pressure for 2 weeks.

Endovascular repair of a ruptured subclavian artery aneurysm in a patient with Ehlers–Danlos syndrome using a sandwich technique

We present the case of a type IV Ehlers-Danlos syndrome patient with a ruptured right subclavian artery aneurysm and associated arteriovenous fistula who underwent successful endovascular repair requiring simultaneous stent graft repair of the innominate artery using a sandwich technique. A 17-year-old man with known type IV Ehlers-Danlos syndrome developed right neck and shoulder swelling. CTA study demonstrated a 17 × 13-cm ruptured subclavian artery aneurysm with an associated internal jugular vein arteriovenous fistula. In the hybrid suite, a 7 mm × 15-cm stent graft (Viabahn, WL Gore & Associates, Flagstaff, AZ) was advanced from the right brachial approach into the innominate artery. A separate wire was placed into the right carotid artery via the right femoral approach (7 Fr), and a 7 mm × 10-cm stent graft (Viabahn) was advanced into the innominate artery. An additional 8 mm × 10-cm stent graft (Viabahn) was placed from the right brachial approach to obtain a distal-landing zone in the axillary artery. Complex vascular anatomy, in which graft seal creation may be challenging, does not exclude endovascular approaches as the sandwich technique can be utilized as a suitable alternative to open repair.

Aortoesophageal Fistula after Endovascular Repair for Aberrant Right Subclavian Artery Aneurysm

A 76-year-old woman with malignant rheumatic arthritis developed dysphagia and hoarseness secondary to an aberrant right subclavian artery aneurysm. We performed a hybrid endovascular repair with concomitant surgical treatment for the aberrant right subclavian artery aneurysm. One month after discharge, she was emergently admitted to our hospital because of chest pain and fever. We diagnosed aortoesophageal fistula and stent graft infection based on computed tomography, gallium scintigraphy, and esophagoscopy results. Esophagectomy, elimination of the infected stent graft, and muscle plombage were performed during several surgeries. However, she died of hemorrhagic shock secondary to an aortobronchial fistula.

Successful surgical treatment of right subclavian artery aneurysm : report of two cases

Successful surgical treatment of right subclavian artery aneurysm : report of two cases

Dartevelle Approach for Intra-Thoracic Subclavian Artery Aneurysm Repair

Subclavian artery aneurysm is a rare phenomenon in the West, but its prevalence is increasingly proportionate to incidence of atherosclerotic disease in the population. It is generally accepted that gold standard care is surgical resection but with limited experience opportunity remains to optimise this. We report on a 66-year-old female arteriopath with an 8 cm intra-thoracic aneurysm of the right subclavian artery, just distal to the brachiocephalic trunk. Lack of a proximal landing zone prohibited endovascular repair thus we utilised the anterior transcervical approach described by Dartevelle. This approach provided excellent visualisation of the aneurysm, along with right vagus and phrenic nerves, facilitating proximal and distal control and subsequent decompression. Post operative recovery was swift and not marred by substantial pain or inhibition of chest wall mechanics, associated with median sternotomy and thoracotomy incisions usually advocated for such aneurysms. As such we purport this approach to offer excellent operative exposure for this increasing disease burden, with less morbidity associated than the currently accepted approach, representing an advance in the management of this condition.

Subclavian and axillary arterial aneurysms: two case reports

Aneurysms of the subclavian-axillary segment are rare, but when diagnosed they must be treated. This article describes two cases of aneurysms of the upper extremities, one in a subclavian artery and the other in an axillary artery. The first case was a 71-year-old male with a pulsating supraclavicular bulge on the right and muscle weakness in the ipsilateral extremity. Duplex scanning and arteriography confirmed the diagnosis of aneurysm of the right subclavian artery and the patient underwent aneurysmectomy and end-to-end anastomosis. The second case was a 24-year-old female patient, with no history of comorbidities, who presented with a pulsating mass in the right axillary region and paresthesia of the ipsilateral extremity. Duplex scanning and arteriography confirmed an aneurysm in the right axillary artery, which was successfully treated with aneurysmectomy and end-to-end anastomosis. Pathology findings showed that the first case was an atherosclerotic aneurysm and the second was a congenital aneurysm.

Hybrid Repair of an Isolated Left Subclavian Artery Aneurysm Associated with a Right-Sided Aortic Arch

Hybrid Repair of an Isolated Left Subclavian Artery Aneurysm Associated with a Right-Sided Aortic Arch

Our incision types of choice for surgical treatment of true aneurysms of subclavian and axillary arteries

Background Subclavian and axillary arteries true aneurysms are rarely seen. The best incision for surgical approach is median sternotomy for intrathoracic right subclavian artery aneurysm, left thoracotomy for intrathoracic left subclavian artery aneurysm and supraclavicular incision for extrathoracic ones. Many surgeons approaches as subclavicular incision, subclavicular incision extending to axillary incision, anterolateral incision and posterolateral incision are also commonly used.

Characteristics of postoperative early and late period for surgical treatment of true aneurysms of subclavian and axillary arteries

Methods Eight patients that were operated on between February 1998 and December 2007 due to true aneurysms of the subclavian and axillary arteries were examined retrospectively in terms of clinical and perioperative parameters. Median age of the patients was 58 (38-73). Six of them were male (75%). Six patients had axillary and 2 patients had subclavian artery aneurysms. : Postoperative intubation time, duration of intensive care unit stay, amount of blood products used, complications as surgical wound infections and bleeding were recorded. After the discharge, patients were examined with Doppler ultrasound at the 1st month and 1st year control visits.

An unusal case of coarctation associated with hypoplasia of the aortic arch and tissue paper aortic wall thickness: a difficult surgical problem

Background Coarctation of the aorta is frequently associated with aortic arch hypoplasia. This combination is more frequent in neonates, often with severe symptoms and in critical condition. We report an isolated case of aortic arch hypoplasia with tissue paper aortic wall and subclavian artery aneurysm in a young adult that was repaired successfully.

An unexpected complication and an endovascular solution during endovascular repair of subclavian artery and thoracic aorta aneurysm

Methods A 61 years old man with abdominal endovascular aortic stent-graft inserted previously, had a saccular aneursym of descending aorta distal to left subclavian artery and a small dissection flap with saccular aneursym originating from left subclavian artery. Since the patient refused to have any surgical procedure for left subclavian artery revascularisation, thoracic aortic-stenting for descending aorta just below the subclavian origin and a second stent-graft for left subclavian artery just above the orifice was planned. Coverage of left subclavian artery was not preferred aiming to avoid possible cerebrovascular events. During intervention, stent-graft to be inserted inside subclavian artery migrated totally into aortic arch in a perpendicular fashion.

An unexpected complication and an endovascular solution during endovascular repair of subclavian artery and thoracic aorta aneurysm

An unexpected complication and an endovascular solution during endovascular repair of subclavian artery and thoracic aorta aneurysm

Our graft choice for surgical treatment of true aneurysms of subclavian and axillary arteries

Results One patient with subclavian artery aneurysm underwent resection of the aneurysm and subclavian-axillary bypass surgery with brachial embolectomy using a polytetrafluoroethylene (PTFE) graft; whereas the other patient underwent resection of the aneurysm and subclavian-axillary bypass surgery with saphenous vein graft. In addition to resection of the aneurysm, three out of 6 patients with axillary artery aneurysm underwent saphenous vein graft interposition and remaining 3 underwent PTFE graft interposition. Moreover, one patient with acute ischemia underwent an additional brachial embolectomy.