Subclavian Artery Aneurysm Research Articles

Endovascular repair of subclavian artery aneurysms: results from a single-center experience

To present our experience of the endovascular treatment of subclavian artery aneurysms (SAAs) and analyze the clinical manifestations, imaging findings and treatment outcomes. In this retrospective study, nine patients with SAAs underwent endovascular stent placement in our center between July 2011 and June 2016. Clinical features, imaging findings, treatment outcomes and follow-up results of these SAA patients were retrospectively analyzed. Nine patients were diagnosed with SAAs by computer tomography angiography (CTA). Five patients underwent percutaneous endovascular stent placement in the subclavian artery. Three patients underwent endovascular repair of the SAAs with coil embolization and stent graft. One patient underwent stent graft implantation by the simultaneous kissing stent technique. Five patients had their symptoms relieved and thrombosis occurred in one case. The mean follow-up period was 17 months, ranging from 8 to 40 months. For patients with SAAs, endovascular treatment is a feasible choice, with a high success rate, few complications and good clinical outcomes.

A 10-Year Experience Using a Hybrid Endovascular Approach to Treat Aberrant Subclavian Arterial Aneurysms

The aim of the study was to describe a single-center experience using combined extra-anatomic open arch branch revascularization with aortic arch endovascular exclusion for treatment of aberrant subclavian artery aneurysms. All patients undergoing management of aberrant subclavian aneurysms were identified from a prospective patient registry. Means of revascularization included carotid-subclavian bypass or subclavian transposition, and origin occlusion was performed by surgical ligation or endovascular embolization at surgeon discretion. Completion of aneurysm exclusion was performed using available distal arch/thoracic aortic endografts (TEVARs) using standard oversizing. Procedures were staged as appropriate based on patient condition. Ten patients, 8 females and 2 males ranging from 32 to 85years of age, were identified. Presenting symptoms were dysphagia (n=9) and acute type B aortic dissection (n=1). All patients required revascularization/exclusion of bilateral subclavian arteries to enable >20mm proximal aortic fixation distal to the common carotid origins for the arch endograft. TEVAR with planned coverage of both subclavian origins extending into the proximal descending thoracic aorta was performed using transfemoral access (n=9) or iliac conduit (n=1) and required a single device (100-157mm) in all cases except the aortic dissection which required total length coverage of the descending thoracic aorta. Extra-anatomic revascularization and thoracic endografting were staged by 1-2days in most cases to minimize potential airway edema from bilateral neck exposures. Subclavian revascularization was performed by carotid-subclavian bypass using polytetrafluoroethylene (n=17) or subclavian transposition (n=3) with proximal occlusion using embolization with an Amplatzer II plug (n=11) or ligation (n=9). No major complications occurred including spinal cord ischemia, stroke, cranial nerve deficit, arm ischemia, access site complications, or wound complications. Length of stay ranged from 6 to 21days with all patients having resolution of dysphagia on follow-up (mean 41months). Directed imaging was available for 7 patients demonstrating the absence of endoleak, regression or stability of aneurysm size, and patency of all subclavian revascularizations. We present a hybrid repair technique with low operative morbidity that has shown to be durable in follow-up and to provide symptomatic relief for patients with aberrant subclavian artery aneurysms causing esophageal compression.

A Ten-Year Experience Using a Hybrid Endovascular Approach to Treat Aberrant Right Subclavian Arterial Aneurysms

To describe a technique of combined extra-anatomic arch branch revascularization with aortic arch endovascular exclusion for treatment of aberrant right subclavian artery aneurysms.

Intravascular Treatment of Left Subclavian Artery Aneurysm Coexisting with Aortic Coarctation in an Adult Patient.

Coexistence of aortic coarctation with aneurysm of subclavian artery is a uncommon situation and may require unusual treatment in patients.A 40-year-old patient diagnosed incidentally with left subclavian artery aneurysm coexisting with aortic coarctation. Patient was initially referred for hybrid treatment. Initially ostium of the left subclavian artery was covered with a stent-graft. Over a 30-month follow-up period aneurysm became thrombosed all the way up to the ostium of internal mammary artery. The patient did not present with neurological symptoms or signs of upper limb ischemia. Taking into consideration good blood supply to the axillary artery via reversed blood flow in the thyreocervical trunk, hence we decided not to proceed with cervicoaxillary bypass grafting.Implantation stent-graft into aorta coarctation with covering axillary artery is proper way of treatment and may need no other surgical procedures.

A case of subclavian artery aneurysm with history of ischemic heart disease operated under cervical epidural anesthesia

Subclavian artery aneurysm is usually operated under general anesthesia (GA), but in specific situations, it can also be conducted under regional anesthesia (RA) such as cervical epidural anesthesia (CEA). A 48-year-old male presented with chief complaint of progressive swelling in the right side of the neck for the past 3 months following trauma. He was diagnosed as subclavian artery aneurysm, and surgical intervention was advised. He had previous history of angina 4 months back for which tablet aspirin 75 mg and tablet clopidogrel 75 mg once daily was prescribed. Cardiological evaluation revealed of an ejection fraction of around 30% with mild left ventricular hypokinesia and grade 2 diastolic dysfunction. Due to the poor cardiac functional status of the patient, RA with CEA was planned. The risk with GA in cases with a history of myocardial ischemia is more than RA, hence, it is better to use CEA which is equally efficacious in such high-risk cases.

Giant subclavian artery aneurysm: Case report and review of literature

Upper extremity aneurysms are quite uncommon when compared to other peripheral arterial aneurysms. Among them, giant (>5 cm) subclavian artery aneurysms (SCAAs) are extremely rare. We report a case of giant SCAA measuring 8.8 cm in its maximal diameter with an updated review of literature. Our case is unique in view of surgical exposure method used (modified trapdoor thoracotomy with claviculectomy).

Правая дуга аорты в сочетании с дивертикулом Коммерелля, стенозом и аневризмой аберрантной левой подключичной артерии – одномоментная коррекция

Правая дуга аорты в сочетании с дивертикулом Коммерелля, стенозом и аневризмой аберрантной левой подключичной артерии – одномоментная коррекция

大動脈弁上狭窄および低形成弓部大動脈術後の鎖骨下動脈瘤 : von Willebrand 病の小児における1治験例

大動脈弁上狭窄および低形成弓部大動脈術後の鎖骨下動脈瘤 : von Willebrand 病の小児における1治験例

Добавочное шейное ребро как причина синдрома грудного выхода и аневризмы подключичной артерии, осложненных дистальной тромбоэмболией

Добавочное шейное ребро – врожденная костная аномалия, являющаяся одной из причин (до 4,5% случаев) синдрома грудного выхода. Данная костно-мышечная аномалия и ее патологическое воздействие на сосудисто-нервный пучок нередко становятся источником тяжелых тромбоэмболических осложнений. Кроме того, врожденный характер патологии и длительное малосимптомное течение способствуют формированию сложных патофизиологических механизмов, которые плохо поддаются лечению, в том числе хирургическому, даже при условии выполнения патогенетически обоснованной и радикальной операции. Тем не менее выявление такой костной аномалии, особенно в сочетании с осложненным течением, является абсолютным показанием к оперативному лечению, поскольку только хирургическое вмешательство позволяет избежать развития необратимых и драматичных тромбоэмболических сосудистых осложнений. Чем раньше будет выполнена операция, тем благоприятнее прогноз лечения, особенно при синдроме грудного выхода с артериальным компонентом. HTML

Upper Extremity Aneurysms

Aneurysms of the upper extremity arteries can be divided into those that occur in the central great vessels and those that occur in the arteries of the upper extremity. Aneurysms of the great vessels tend to be atherosclerotic in nature and are frequently the extension of an arterial field defect in patients with other aneurysmal disease. In contrast, aneurysms of the upper extremity arteries are mostly pseudoaneurysms that result from either acute or recurrent trauma or iatrogenic injury. Although the underlying principles of management are similar, the magnitude of the operations vary significantly. This review covers aneurysms of the great vessels and aneurysms of the peripheral upper extremity arteries. Figures show a computed tomographic angiogram demonstrating bilateral subclavian artery aneurysms in an individual with Marfan disease; the aberrant right subclavian artery originating from the thoracic aorta distal to the left subclavian orifice and coursing behind the esophagus as it travels back to the right hemithorax and arm; arterial thoracic outlet syndrome associated with compression of the subclavian artery as it travels through the scalene triangle and between the first rib and clavicle; the extent of arterial replacement necessary to treat great vessel aneurysms; isolated great vessel aneurysms with adequate proximal and distal landing zones treated with endovascular placement of a covered stent; hybrid operations combining endovascular exclusion of the great vessel aneurysm and transcervical extra-anatomic revascularization as an alternative to open surgery when placement of a traditional stent graft is not anatomically feasible; and an angiogram demonstrating a traumatic axillary artery. Tables list symptoms associated with great vessel aneurysms, distribution of aneurysm locations in the major series of great vessel aneurysms, and outcomes of major series of great vessel aneurysms. This review contains 7 highly rendered figures, 3 tables, and 68 references. Key words: axillary artery aneurysm; great vessel aneurysm; peripheral upper extremity aneurysm; subclavian artery aneurysm; thoracic outlet obstruction; upper extremity aneurysm

Recurrent Embolic Stroke due to a Saccular Aneurysm of Left Subclavian Artery: Endovascular Treatment

Recurrent Embolic Stroke due to a Saccular Aneurysm of Left Subclavian Artery: Endovascular Treatment

A 38-Year-Old Man With Marfan Syndrome and Bilateral Subclavian Artery Aneurysms

A 38-year-old man with Marfan syndrome, with a history of aortic dissection and aneurysmal degeneration that had been previously repaired with a valve-sparing ascending aortic replacement and a thoracoabdominal aorta repair from the ascending repair through the common iliac arteries with renal and mesenteric debranching, presented for asymptomatic bilateral subclavian artery aneurysms found on surveillance imaging. He had a 4-cm aneurysm on the right and a 2-cm aneurysm on the left. He had been lost to follow-up for 5 years. Because of his median sternotomy and his severe pectus excavatum, we thought that a staged cervical hybrid repair was best. He underwent a right subclavian artery repair with reimplantation of the right vertebral artery onto the common carotid and a carotid-subclavian bypass, along with a retrograde exclusion of the right subclavian artery origin with a Gore Excluder (W. L. Gore & Associates, Flagstaff, Ariz). One month later, he developed acute chest and shoulder pain associated with a dissection and enlargement (2 cm to 2.3 cm in 6 weeks) of his left subclavian artery aneurysm. He was subsequently taken for repair of the left subclavian artery by left common carotid to axillary artery bypass, reimplantation of the left vertebral artery onto the left common carotid, and Amplatzer plug occlusion of the prior arch branch to the left subclavian. Postoperatively, the patient did develop a minor hospital-acquired pneumonia that resolved with antibiotics and aggressive pulmonary hygiene. Subclavian artery aneurysms are rarely associated with Marfan syndrome. We review different approaches to subclavian artery aneurysms.

A giant intrathoracic right subclavian artery aneurysm: a case report

A giant intrathoracic right subclavian artery aneurysm: a case report

Short- and Long-term Results of Hybrid Arch and Proximal Descending Thoracic Aortic Repair

Purpose: To evaluate the short- and long-term outcomes of hybrid repair of the arch and proximal descending aorta in a single tertiary center for aortic disease. Methods: A retrospective analysis was performed of 55 patients (median age 67 years; 36 men) who underwent hybrid repair of thoracic aortic pathology with involvement of the arch between January 2005 and May 2015 at a single tertiary center. The pathologies included 40 (73%) with aneurysmal disease, 10 (18%) acute type B aortic dissections, 2 with acute aortic syndrome, an acute type A dissection, and left and aberrant right subclavian artery aneurysms. Seven (13%) procedures were performed as an emergency. Demographics and procedure characteristics were collected for analysis of survival and reinterventions. Results: Complete aortic debranching was performed in 14 (25%) to facilitate endograft placement in zone 0; debranching was partial in 20 (36%) patients for zone 1 deployments and 21 (38%) for zone 2. Primary technical success was achieved in 51 (93%) cases. One patient died in-hospital from aneurysm rupture following aortic debranching prior to stent-graft repair. In another, the stent-graft procedure proved infeasible and was abandoned. The other 2 technical failures were due to type Ia endoleaks. Five (9%) patients died in-hospital (4 of 48 elective and 1 of 7 emergency cases); 2 of these patients died within 30 days (4%). Eight (14%) patients had a stroke, 6 of 48 elective and 2 of the 7 emergency patients. Spinal cord ischemia was reported in 3 (6%) patients. Mean follow-up was 74.6 months. Overall cumulative survival was 70% at 1 year, 68% at 2 years, and 57% at 5 years. Reintervention to the proximal landing zone for type Ia endoleak was required in 6% of cases. The overall rate of aortic reintervention was 18% at 1 year, 21% at 2 years, and 36% at 5 years. Overall extra-anatomic graft patency was 99%. Conclusion: Hybrid repair of the aortic arch and proximal descending thoracic aorta is technically feasible, with acceptable short-term mortality. There is a low rate of proximal landing zone reintervention when hybrid techniques are used to create an adequate proximal landing zone. Extra-anatomic bypass grafts have good long-term patency. Ongoing disease progression means that further distal aortic interventions are often necessary in patients with extensive disease.

Young Lady with Acute Upper Limb Ischemia due to Cervical Band

Introduction: Acute upper limb ischemia is usually caused by compression of cervical rib on subclavian artery. But in very few cases compression may be caused by cervical band which is not evident in conventional radiography.Results and Discussion: This is a case of a 26 year old lady, housewife, having rudimentary cervical rib, presented with acute left upper limb ischemia due to subclavian artery aneurysm. Peroperatively cervical fibrotic bandwas identified and diagnosed as the cause of subclavian artery aneurysm instead of rudimentary cervical rib. Scalenectomy, excision of the cervical band, excision of the aneurysmsac and arterial reconstruction of the subclavian artery was performed. Her operation was uneventful, postoperative recovery was excellent. She was discharged to home on 4th postoperative day ensuring good distal pulsation of affected limb.Conclusion: Though rare, cervical band is a cause of acute upper limb ischemia. So, we must not forget while diagnosing this type of cases.J Bangladesh Coll Phys Surg 2015; 33(2): 101-104

Critical Upper Limb Ischemia due to Subclavian Artery Compression Caused by Initially Undiagnosed Cervical Rib - A Case Report

True subclavian artery aneurysms are relatively rare events. Thoracic outlet compression is responsible for 75% of those aneurysms. They are formed as a result of compression of subclavian artery, for example a cervical rib. A case of subclavian artery aneurysm secondary to cervical rib in a 35 year old young adult, who presented with a critical ischemia in his dominant right upper limb. Plain x-ray of cervical spine revealed bilateral cervical ribs and duplex study of the both upper limb arteries concluded aneurysmal dilatation of mid-distal subclavian artery of both sides with mural thrombus on the right side, marked distal ischemia in the right upper limb due to occlusive thrombus in the distal arterial tree, normal distal arterial flow in the left upper limb. Although it is a rare lesion, cervical rib leading to thoracic outlet compression should always be included in the differential diagnosis of a critically ischemic limb in young age group. Surgical management should be considered in a patient with subclavian artery aneurysm due to cervical rib to prevent additional embolic events.University Heart Journal Vol. 11, No. 1, January 2015; 48-51

Upper-to-lower-limb Collateral Circulation in a Patient with Aortic Coarctation

A 35-year-old male was hospitalized with a pulsatile mass in the left shoulder region. He had a history of uncontrolled hypertension for more than 5 years. A computed tomography angiogram revealed a giant left subclavian artery aneurysm and also an aortic coarctation (A). Interestingly, hypoplasia of the right common/external iliac arteries was present, and significant collateral circulation was noted between the right subclavian artery and the distal right external iliac artery, restoring blood flow to the right lower extremity (B). This could explain why this patient had a normal ankle brachial index and did not suffer from intermittent claudication.

Endovascular treatment of the subclavian artery aneurysm in high-risk patient - a single-center experience.

We present our first experience with endovascular treatment of 6 subclavian artery aneurysms (SAA) occurring in five male and one female patient. All patients, in our studies, according to ASA classification were high risk for open repair of SAA. The etiology of the all aneurysms was atherosclerosis degeneration of the artery. Two aneurysms were of intrathoracic location, then the other were extrathoracic. Symptoms related to subclavian artery aneurysms were present in two patients, compression and chest pain in one, and hemorrhage shock in second, while the remaining patients were asymptomatic. We preferred the Viabhan endoprosthesis for endovascular repair in 5 cases. In one patient with ruptured of subclavian artery aneurysm who was high-risk for open repair we made combined endovascular procedure. First at all, we covered the origin of left subclavian artery with thoracic stent graft and after that we put two coils in proximal part of subclavian artery. There was no operative mortality, and the early patency rate was 100%. The follow-up period was from 3 months to 3 years. During this period, one patient died of heart failure and one patient required endovascular reoperation due to endoleak type I. Endovascular treatment is recommended for all patients with subclavian artery aneurysm whenever this is possible due to anatomical reasons especially in high-risk patient with intrathoracic localization of aneurysm, to prevent potential complications.

Results of aberrant right subclavian artery aneurysm repair

The objective of this multicenter registry was to review current treatments and late results of repair of aneurysm of aberrant right subclavian artery (AARSA). All consecutive AARSA repairs from 2006 to 2013 in seven centers were reviewed. End points were 30-day and late mortality, reintervention rate, and AARSA-related death. Twenty-one AARSA repairs were included (57% men; mean age, 67 years); 3 ruptures (14%) required emergent treatment; 12 (57%) were symptomatic for dysphagia (33%), dysphonia (24%), or pain (19%). Eight cases (38%) presented with thoracic aortic aneurysm, two with intramural hematoma, and one with acute type B aortic dissection. Mean AARSA diameter was 4.2 cm; a single bicarotid common trunk was present in 38% of cases. The majority of patients underwent hybrid intervention (n = 15; 71%) consisting of single (n = 2) or bilateral (n = 12) subclavian to carotid transposition or bypass or ascending aorta to subclavian bypass (n = 1) plus thoracic endovascular aortic repair (TEVAR); 19% of cases underwent open repair and 9% simple TEVAR with AARSA overstenting. Perioperative death occurred in two patients (9%): in one case after TEVAR in ruptured AARSA, requiring secondary sternotomy and aortic banding; and in an elective case due to multiorgan failure after a hybrid procedure. Median follow-up was 30 (interquartile range, 15-46) months. The Kaplan-Meier estimate of survival at 36 months was 90% (standard error, 0.64). Late AARSA-related death in one case was due to AARSA-esophageal fistula presenting with continuing backflow from distal AARSA and previous TEVAR. At computed tomography controls, one type I endoleak and one type II endoleak were detected; the latter required reintervention by aneurysm wrapping and ligature of collaterals. AARSA-related death was more frequent after TEVAR, a procedure reserved for ruptures, compared with elective open or hybrid repair. Hybrid repair is the preferred therapeutic option for patients presenting with AARSA. Midterm results show high rates of clinical success with low risk of reintervention. Simple endografting presents high risk of related death; these findings underline the importance of achieving complete sealing to avoid treatment failures.

Shoulder Injury - Motor Vehicle Accident in a Tennis Player

HISTORY: A 31-year-old male tennis player and musician was in motor vehicle accident. He was the restrained driver, flipped upside down hanging by seatbelt, no airbag deployment. Developed left shoulder pain with electricity sensation and a pulsing sensation near left midshaft clavicle. PHYSICAL EXAM: No tenderness of sternoclavicular or acromioclavicular joint, clavicle. Flexion and abduction 0-180 degrees, external rotation 0-90 degrees, internal rotation to T6. Negative Jobe’s, Neer’s and Hawking’s. Full strength of rotator cuff. Mild tenderness to palpation and thrill of left subclavian artery superior to midshaft clavicle. Positive Wright’s and Roos. Negative Spurling, Lhermitte, Naffziger sign. Hypoesthesia to anterior cervical triangle. DIFFERENTIAL DIAGNOSIS: 1. arteriovenous malformation of subclavian artery 2. thoracic outlet syndrome 3. pseudoaneurysm 4. subclavian artery thrombus 5. clavicle fracture 6. brachial plexopathy TESTS AND RESULTS: - XR left clavicle (2 weeks): No acute fracture. Mild deformity of left first rib, more suggestive of old trauma. - MRI L brachial plexus (2 weeks): Mild left brachial plexus edema suggesting mild neuritis or stretching injury. - CT neck and chest with IV contrast (10 weeks): No soft tissue mass noted at left supraclavicular region. There is fracture at 1st rib with superior angulation of the fracture site deep to the area of interest. - office ultrasound (12 weeks): L subclavian artery 7mm x 3.8cm, corresponds to patient’s location of pain. - vascular ultrasound (15 weeks): no evidence of subclavian artery aneurysm. - CT angiography chest (16 weeks): Pseudoarthrosis of hypoplastic left first rib with lateral second rib. Pseudoarticulation abuts undersurface of mid left subclavian artery without significant extrinsic compression. Left subclavian artery is slightly dilated with questionable surrounding stranding, may suggest stretch injury. No aneurysm or dissection. FINAL/WORKING DIAGNOSIS: left subclavian artery shear/stretch injury TREATMENT/OUTCOME Initially treated with rest and NSAIDs. About 4 weeks post-injury, 7-day course of prednisone 50mg given for brachial plexus injury. Physical therapy started at 13 weeks to stretch scalenes, pectoralis minor, first rib glide. Has not yet returned to activity (at time of submission).