症状性锁骨下动脉狭窄或闭塞的腔内治疗效果分析

目的 探讨症状性锁骨下动脉窃血综合征患者血管腔内技术治疗的临床有效性和安全性。方法 选取首都医科大学附属北京朝阳医院血管外科2011年1月至2015年8月收治的症状性锁骨下动脉狭窄或闭塞患者38例,其中男27例,女11例;平均年龄为（66.2±10.8）岁。患者均表现为头晕等神经系统症状,部分合并上肢缺血症状。运用血管腔内技术,对锁骨下动脉进行球囊扩张成形及支架植入术。结果 36例患者均成功植入球扩式支架,术后双上肢收缩压差显著改善,神经系统症状消失或改善33例,无效2例,1例术中发生脑梗死,经康复锻炼后好转;2例操作没成功,保守治疗。随访期间再狭窄3例,支架断裂1例。结论 严格掌握适应证,采用腔内技术治疗锁骨下动脉狭窄或闭塞的神经系统症状安全有效,操作简单。     

Operation for huge subclavian artery aneurysm: a case report

Subclavian artery aneurysm is extremely rare, and further aneurysm compressing trachea and leading to breathing difficulty is more exceptional. The most common causes of subclavian artery aneurysm are atherosclerosis, trauma and post-stenotic dilated aneurysm secondary to thoracic outlet syndrome, besides, the rare causes include infective, syphilitic media necrosis and so on. We present a case report in which the patient presented with sever dyspnea due to compression of trachea by a 7 cm large subclavian artery aneurysm. After operation, the patient improved symptomatically. The blood pressure remained stable, blood circulation of right upper extremity was fine, and pulse was improved comparing with that before operation. Chest film confirmed tumor shrank and depressed trachea improved significantly. The patient was discharged 14 days later and continued anticoagulant therapy after discharge. Follow up one month later after the operation revealed breathing difficulty disappeared, and patient was with normal right upper extremity movement and good blood circulation.     

Isolated subclavian artery aneurysm: evaluation by transesophageal echocardiography

A 50-year-old man was evaluated following a motor vehicle accident. Chest X-ray showed a widened mediastinum. Transesophageal echocardiography was helpful in identifying the left subclavian artery and in demonstrating an isolated subclavian artery aneurysm. The TEE findings correlated well with the results of chest CT. Using TEE for the identification of the aortic branches in patients with chest trauma may be critical.     

Aneurysm of the subclavian artery: A complication of retrograde brachial artery catheterization

A case of an aneurysm of an anomalous right subclavian artery following retrograde catheterization of the right brachial artery is described. This complication was not recognized until the patient presented with symptoms related to a superior mediastinal mass. After appropriate studies were performed operative intervention was successful in establishing a patent subclavian artery.     

Aneurysms of an aberrant right subclavian artery: report of two cases

Aneurysm of the aberrant right subclavian artery is rare. We report two patients who underwent successful repair using hypothermic circulatory arrest and retrograde cerebral perfusion. One patient presented with progressive dysphagia to solids and hoarseness of voice due to pressure exerted by the expanding aneurysm, and the second patient, with a dissected subclavian aneurysm, presented with transient ischaemic attacks and a previous cerebral infarct secondary to embolism. Repair in both patients was done through a median sternotomy with femoral arterial and right atrial venous cannulation. Under hypothermic circulatory arrest, the origin of the subclavian aneurysm was divided off the aorta and closed with a Dacron patch from outside the aorta in one patient, and from within the aorta in the other patient. Concomitant revascularisation of the right upper limb was achieved using a 12-mm Hemishield Dacron graft from the ascending aorta to the distal right subclavian artery. The graft to subclavian anastomosis was done under hypothermic circulatory arrest as distal control was not possible. The graft to the aortic anastomosis was done over a side-biting clamp during rewarming. Both patients were successfully treated without major morbidity.     

Endovascular treatment of the subclavian artery: stent implantation with or without predilatation.

The endovascular treatment of subclavian artery (SA) lesions is less invasive than open surgical repair, with a low rate of complications. We report our experience in 89 subclavian obstructive lesions (n = 86) treated with stenting: 76 (85.3%) stenoses and 13 (14.6%) total occlusions. The left side was most frequently involved (83.1%), localized at the prevertebral segment in 91%. Technical success was obtained in 83 (93.3%) cases, 100% in stenotic lesions and 53.8% in total occlusions. There were nine global complications (10.1%): five (5.6%) at site of puncture, two distal embolization (2.2%), and two (2.3%) major events. The long-term follow-up was 3.51 +/- 1.98 years, during which time 13 (16.8%) restenoses and 2 (2.6%) reocclusions were noted. Subgroup analysis of patients with stenting after predilatation versus direct stenting technique showed in-hospital complications only in the first group, with a restenosis rate of 28.5% vs. 4.7%, respectively (P = 0.003). We consider stenting for SA obstructive lesions the first therapeutic option.     

Concomitant coronary and subclavian steal caused by ipsilateral subclavian artery stenosis and arteriovenous fistula in a hemodialysis patient.

Patients with chronic renal failure, because of concomitant conventional cardiovascular and uremia-associated risk factors, are at risk of developing diffuse and accelerated atherosclerosis involving both the coronary and peripheral territories. We report an end-stage renal failure patient with a history of coronary artery bypass surgery who developed both angina and dizziness during hemodialysis via a left forearm arteriovenous fistula. Magnetic resonance imaging diagnosed the presence of significant subclavian artery stenosis. The patient then underwent successful percutaneous stenting of the left subclavian artery. His angina and dizziness symptoms resolved subsequently.     

Immediate and late outcomes of subclavian artery stenting

Stenting for subclavian artery occlusive disease is being increasingly utilized. To determine the immediate and late outcome of subclavian artery stenting, we studied 38 consecutive patients in whom the procedure was attempted. Technical and clinical success was achieved in 35 patients without complications. Failures occurred only in completely occluded arteries. Late clinical success was demonstrated in 31 patients. Three patients had recurrent symptoms. Two had angiographic restenosis within 4 months of the procedure; both were successfully redilated. The third patient had a new lesion, which was successfully stented. One patient died from lung cancer 10 months after the procedure. We conclude that stenting for subclavian artery occlusive disease has favorable immediate and late clinical outcomes and may be considered as a primary therapy. Cathet. Cardiovasc. Intervent. 46:169–172, 1999. © 1999 Wiley-Liss, Inc.     

胸主动脉腔内修复体外开窗与选择性隔绝左锁骨下动脉的前瞻性队列研究

【摘要】目的 探讨胸主动脉腔内修复（TEVAR）体外开窗与选择性隔绝左锁骨下动脉的安全性和有效性。 方法 前瞻性队列研究分析 2012 年 9 月至 2017 年 10 月十堰市太和医院心脏大血管外科收治的 117 例胸主动脉病变患者的临床资料,根据左锁骨下动脉处理方式不同分为直接选择性隔绝LSA腔内修复组（endovascular exclusion,EE）和体外开窗LSA腔内修复组（invitro fenestration,IF）,比较两组患者的治疗效果和3年随访结果。结果 围术期结果上,EE组手术时间( 62.0 ± 5.4 )min短于IF组,脑梗塞、左上肢缺血发生率分别为7.14%（4/56）、10.71 % ( 6 / 56 )高于IF组,差异有统计学意义（ P 均＜ 0.05 ）;EE组的内漏、脊髓缺血、术后 30 天病死、支架覆盖T10发生率分别为 5.36 % （ 3 / 56 ）、 5.36 %（ 3 / 56 ）、 1.79 % （ 1 / 56 ）、 12.50 % ( 7 / 56 )与IF组相比,差异无统计学意义（ P 均＞ 0.05 ）。随访结果方面,生存出院患者 116 例,失访 12 例,持续随访 104 例,随访率 89.7 ％（ 104 / 116 ）。随访时间 36~60 个月,平均（ 38.1 ± 3.2 ）月。3 年随访结果显示EE组未增加主动脉源性死亡,但脑梗塞和上肢缺血发生率高于IF组。EE组、IF组随访3年累计生存率分别为 82.23 % 和 85.19 % 。两组间 3 年生存曲线总体比较差异无统计学意义（X2=0.055, P=0.814 ）。 结论 选择性隔绝左锁骨下动脉腔内修复可缩短手术时间,有效延长锚定区,降低内漏发生,但增加脑梗塞、脊髓缺血、左上肢缺血发生风险,体外开窗重建左锁骨下动脉腔内修复手术并发症低,两组中期随访结果满意,远期尚需进一步评估。     

Screening for subclavian artery stenosis in patients who are candidates for coronary bypass surgery.

We prospectively evaluated 59 patients who were deemed candidates for coronary bypass surgery after coronary artery angiography for subclavian artery narrowing, which could compromise the ipsilateral internal thoracic artery graft. Bilateral arm blood pressure (BP) measurements, auscultation for supraclavicular or cervical bruits, and questioning about cerebrovascular ischemic symptoms were compared to brachiocephalic-subclavian arteriography. One neurologic complication occurred during arteriography. An upper extremity BP difference of > or = 15 mm Hg identified all patients with > or = 50% subclavian artery narrowing. We recommend brachiocephalic-subclavian arteriography only in patients with abnormal noninvasive screening for subclavian stenosis, not routinely.     

锁骨下动脉粥样硬化性病变介入治疗的长期疗效观察

目的评价锁骨下动脉粥样硬化性病变介入治疗的长期疗效。方法对2003年3月至2011年6月沈阳军区总医院心血管内科诊治的72例锁骨下动脉狭窄或闭塞患者,实施经皮腔内血管成形术与支架植入术治疗,随访观察介入治疗后1年以上的临床疗效。结果72例患者中男性61例（84．7％）,年龄（64．9±9．0）岁,吸烟史48例（66．7％）,原发性高血压病史34例（47．2％）,糖尿病史22例（30．6％）。术前临床表现肢体供血不足62例（86．1％）、椎基底供血不足27例（37．5％）、有血管杂音24例（33．3％）、血管搏动减弱或消失72例（100％）。介入手术成功66例（91．7％）,失败6例（8．3％）。随访36（12～100）个月,随访率97．2％。上述四个方面临床治愈好转率分别为91．9％、88．9％、91．7％、93．1％,恶化病例1例,为介入治疗失败患者行外科人工血管置换术。介入成功患者患侧术后收缩压较其术前明显升高,差异有统计学意义[（115．00±21．21）mmHg vs.（82．92±51．01）mmHg,P〈0．05,1mmHg=0．133kPa]。结论经皮血管腔内介入治疗锁骨下动脉病变安全、有效,长期疗效明确。     

Transesophageal echocardiographic identification of left subclavian artery stenosis with steal phenomenon

In this report, we present the first case of the transesophageal echocardiographic identification of left subclavian artery stenosis and steal phenomenon.     

Coil occlusion of a subclavian mycotic aneurysm

We report the first successful application of nonferromagnetic embolization coils for endovascular exclusion of a mycotic right subclavian artery aneurysm. A 58‐year‐old woman presented with acute cervical pain and a pulsatile mass in the right supraclavicular fossa under antibiotic medication for subacute infectious endocarditis. Diagnostic work‐up including duplex sonography, digital subtraction angiography, and magnetic resonance imaging demonstrated a saccular aneurysm of the extrathoracic right subclavian artery. As an alternative to open surgery or stent‐graft repair, this pathology was electively treated by transcatheter coil embolization. No neurological deficit or ischemic symptoms were noted during 9 months clinical follow‐up. Multislice computed tomography scan revealed complete occlusion of the mycotic aneurysm 6 months after the interventional procedure. Transcatheter closure with Inconel embolization coils is a cost‐effective and safe therapeutic option in patients with mycotic aneurysm originating from the subclavian artery. © 2010 Wiley‐Liss, Inc.     

Aberrant subclavian artery causing difficulty in transhiatal esophageal dissection

The right subclavian artery normally arises from the brachiocephalic artery. Anomalies in development may lead to peculiar problems during surgery. We report a patient with esophageal carcinoma who had an aberrant right subclavian artery, posing specific difficulties during a transhiatal esophagectomy, requiring conversion of the procedure into a transthoracic approach. The embryologic basis of this anomaly and the clinical significance are discussed.     

Percutaneous recanalization of chronic subclavian artery occlusion using optical coherence reflectometry-guided radiofrequency ablation guidewire.

Subclavian artery lesion that is associated with low complication rate could be treated by percutaneous intervention effectively. However, the success of endovascular therapy for occlusive lesion may be limited by failure to cross with a guidewire. We describe the use of a system using optical coherence reflectometry for navigation and radiofrequency ablation to enable wire passage through subclavian artery occlusion that could not be crossed by conventional guidewires.     

Utility of endoscopic ultrasound in the diagnosis of aberrant right subclavian artery

BACKGROUND AND AIMS: Aberrant right subclavian artery (ARSA) is the most common congenital anomaly of the aortic arch occurring in 0.4-2.0% of the general population. Instead of arising from the brachiocephalic artery, the ARSA arises as the last branch from the aortic arch. The aim of this study was to determine the prevalence of ARSA in patients undergoing upper endoscopic ultrasound (EUS) and to describe the EUS characteristics of ARSA. METHODS: A retrospective review was conducted of 7513 upper EUS exams performed from 1 July 2000 to 1 February 2005. RESULTS: In total, 27 (0.36%, 95% CI 0.22-0.50%) of 7513 patients undergoing upper EUS were found to have an ARSA (10 male, 17 female; mean age 58 years, range 23-81 years). Of the 27 patients, 16 had only radial EUS, 10 had radial and linear EUS, and one had only linear EUS. In all 26 patients who underwent radial imaging, a well-defined, anechoic tubular structure was seen originating from the aortic arch and passing between the esophagus and spine. In all 11 patients undergoing linear imaging, the abnormal anatomy was detected and the vascular nature confirmed by Doppler. In one patient, both radial and linear imaging identified unsuspected aneurismal dilatation of the ARSA; a rare condition referred to as Kommerell's diverticulum (KD). None of the other 26 patients had symptoms to suggest an ARSA. Of the 14 patients who had computed tomography (CT) prior to EUS, only four were initially reported to have ARSA. However, later review of the CT scans verified an ARSA in all 14 patients. Of the two patients who underwent a barium swallow, only one had findings suggestive of ARSA. CONCLUSIONS: This report highlights the utility of both radial and linear EUS imaging in identifying previously unsuspected ARSA and associated anomalies. This report also suggests the need for careful review of the CT in patients suspected of having ARSA due to the frequent failure of radiologists to identify, or report, this anomaly when particular focus is not given.     

Double aortic arch with atretic left arch distal to the origin of left subclavian artery accompanied by dyspnea: A case report and literature review

Double aortic arch with atretic left arch distal to the origin of left subclavian artery is a rare type of vascular ring, and it can be easily confused with the right aortic arch with mirror branching. We provided a rare case of a 10‐month‐old infant with dyspnea. Echocardiography showed a suspicious double aortic arch with atretic left arch distal to the origin of left subclavian artery, which was confirmed intra‐operatively. We summarize ultrasonic image characteristics of the disease and combine it with computed tomography angiography, bronchoscopy, and clinical symptoms in order to improve the detection rate and treatment strategy.     

Angioplasty of an asymptomatic total occlusion of the left subclavian artery to provide access for coronary angiography and intervention: a case report.

Reports and follow-up of angioplasty and stenting of asymptomatic totally occluded subclavian arteries are limited. We present a case of unstable angina and arterial occlusion of all four extremities treated with subclavian angioplasty and stenting with subsequent coronary angiography and percutaneous coronary intervention. Twelve-month follow-up is also provided.