A case of successful repair of a left subclavian arterial aneurysm ruptured into the esophagus--review of 89 cases in Japan

This report concerns a case of a left arteriosclerotic subclavian arterial aneurysm ruptured into esophagus. A 61-year-old man who complained of fever, dyspnea, and dysphagia was diagnosed by chest X-ray, selective left subclavian arteriogram, and chest CT. Because he vomited a large amount of blood before an operation, we suspected that the aneurysm had ruptured into the esophagus, and therefore performed an emergency operation. The operative procedure consisted of exposing the aneurysm through a median sternotomy incision with the addition of a left supraclavicular incision, proximal and distal ligation, and reconstruction of blood flow by an aorto-left subclavian artery bypass with a Gore-tex prosthetic graft; however the aneurysm was not resected because of adhesion to the surrounding tissues. The post-operative course was uneventful and the patient is now normal and back at work, 2 years after the operation. Subclavian arterial aneurysms are relatively rare among peripheral arterial aneurysms. The common causes of subclavian aneurysms are arteriosclerosis (18%), trauma (14.6%), non specific inflammation (13.5%), and thoracic outlet syndrome (11%). Of the only 15 ruptures in 89 cases that have been reported in Japan, none have ruptured into the esophagus. Subclavian artery aneurysms represent a risk of rupture or peripheral circulatory failure, and consequently, should be considered for surgical treatment.     

A case report of ruptured mycotic aneurysm at the site of subclavian flap angioplasty]

Postoperative mycotic aneurysm of the thoracic aorta at the site of subclavian flap angioplasty (SFA) is very rare. A 6-year-old boy was admitted with a history of high fever for 10 days. He had undergone SFA at the age of 14 days and patch closure of VSD at 10 months. The chest X-ray film on admission revealed no abnormality. But, 7 days later, he suffered from frequent hemoptysis and chest X-ray film showed an abnormal mass shadow at the left upper lung field. Contrast enhanced CT scan and IV-DSA revealed a pseudoaneurysm of the aortic arch which had ruptured into the left upper lung. An extra-anatomical bypass was urgently made from the ascending aorta to abdominal aorta and the aneurysm was isolated by ligations of the aorta proximal and distal to the aneurysm. Aneurysmectomy combined with left upper lobectomy was carried out next day. Septic signs and hemoptysis dramatically improved after operation. Extra-anatomical bypass as a means of choice for the surgical treatment of the mycotic aneurysm greatly contributed to cure the severe ill patient. But a close follow up observation for the function of the graft is necessary.     

A case report of intrathoracic aneurysm of left subclavian artery

A case of intrathoracic aneurysm of the left subclavian artery is reported. The case was 68-year-old male. Chest CT and angiography revealed an aneurysm of left subclavian artery (LSA) located the proximal portion of LSA. The chest was opened by fourth intercostal thoracotomy. We evaluated the intima of distal aortic arch and LSA by introperative direct echography using a small probe (finger tip size). Since there was no calcification or mural thrombi at the distal aortic arch, the aneurysm was resected using partial cardiopulmonary bypass and the orifice of LSA was closed direct suture. LSA was reconstructed with knitted Dacron graft (8 mm). Postoperative course was uneventful.     

A case of ruptured aortic arch aneurysm into the lung]

Successful surgical treatment of aortic arch aneurysm ruptured into the left lung was reported. The patient was a 74-year-old man suffering from recurrent hemoptysis. Computed tomography and aortic angiography demonstrated a giant aortic arch aneurysm. Emergency operation was performed. Arch reconstruction by a Dacron graft was performed with hypothermic circulatory arrest. The post operative course was uneventful and there was no evidence of cerebral complication. In the emergency operation for ruptured aortic arch aneurysm, hypothermic circulatory is very useful method for cerebral protection.     

A case of abdominal aneurysm accompanied by an aneurysm of left subclavian artery

The case was a 62-year-old man. Two years ago under a diagnosis of aneurysm of the left subclavian artery he received: Ligation of aneurysm, aneurysmorrhaphy and extra anatomic bypass grafting from right axillary artery to left axillary artery. This time we palpated a pulsatile mass on his abdomen and performed replacement of abdominal aorta by Y shaped prosthesis following a diagnosis of abdominal aneurysm. In recent years population of advanced age have been increasing and arteriosclerotic diseases including aneurysm are also remarkably increasing. In the future we think that cases of multiple aneurysms such as this one will increase. In Japan we collected fifty cases of aneurysm of the subclavian artery including our case. In this paper we reviewed those cases and discussed the diagnosis and treatment of aneurysm of subclavian artery and multiple aneurysms.     

A case of ruptured left subclavian artery associated with von recklinghausen's disease

Emergency operation was performed on a 38-year-old woman of von Recklinghausen's disease, who fell in shock due to massive hemorrhage in the left thoracic cavity following rupture of the left subclavian artery. The vascular wall was so fragile that hemostasis was difficult. She survived the operation. Vascular complications in von Recklinghausen disease were discussed.     

Coarctation of the aorta associated with left subclavian artery aneurysm: a case report

Aneurysm of the left subclavian artery (LSA) in association with coarctation of the aorta (CoAo) is a rare phenomenon, especially in the younger population. A 19-year-old male patient was admitted for lower extremity varices and diagnosed to have severe CoAo and a 45-mm LSA aneurysm after digital subtraction angiography following detection of nonpalpable lower extremity pulses on physical examination. Corrective surgery was performed from a left posterolateral thoracotomy through the 4th intercostal space, and a discrete ring-like coarctation tissue was observed in the aorta just below the level of the LSA orifice. Complete excision of the coarctation tissue was followed by aortoplasty with a Dacron patch. Additionally, the subclavian aneurysm was completely excised and a 10-mm Dacron tube graft interposition was performed. Prompt diagnosis and surgical treatment in particularly hypertensive patients precludes significant mortality and morbidity following a possible rupture.     

A case report of atypical coarctation of the aorta with coarctation and left subclavian arterial aplasia

A 18 year-old female was admitted to our hospital with hypertension of 190/100 mmHg in her right arm and 140/110 mmHg in the left arm. Femoral arterial pulsation was not palpable. Her physical status and growth of the lower limbs were normal. Aortography demonstrated slight coarctation with a pressure gradient of 10 mmHg and descending aortic stenosis with a pressure gradient of 80 mmHg. Main three branches from aortic arch were anatomically normal. However, the left subclavian artery distal to the origin of the left vertebral artery was not visualized and the axillary artery was perfused by collaterals. Atypical coarctation was replaced using a woven Dacron graft of 14 x 40 mm. Postoperatively proximal pressure decreased from 180/113 to 156/98 mmHg and there was no pressure gradient between proximal and distal of the graft. After six months blood pressure in the right arm gradually decreased to 120/78 mmHg.     

A successful surgical case of thoracoabdominal aortic aneurysm ruptured into the right pleural cavity]

A 55-year-old man was transferred to our cardiovascular center because of right hemothorax and hemorrhagic shock. Emergency CT scan revealed a thoracoabdominal aortic aneurysm (Crawford's type I-A) ruptured into the right thorax. The aneurysm was exposed by Stoney's spiral opening approach. A 24 mm Cooley Dacron graft was implanted in end-to-end fashion between the descending thoracic aorta and the abdominal aorta just above the celiac artery. The use of aortic artery cannula, femoral artery cannula and flexible polyvinyl tube provided safe and simple means as a temporary bypass during this graft replacement. Postoperative course was uneventful.     

A case of a right subclavian arterial aneurysm associated with the aortic arch anomaly in childhood]

Aneurysms in the subclavian arteries are extremely rare in childhood. A 7-year-old boy was admitted with hoarseness and abnormal shadow in the chest film. Radiologic studies demonstrated a right subclavian arterial aneurysm associated with the aortic arch anomaly. Proximal and distal ligation of the subclavian arterial aneurysm and reconstruction of blood flow by an aorto-subclavian bypass using a 5 mm GORE-TEX prosthetic graft were performed through a standard median sternotomy incision with extension to the right supraclavicular space. The postoperative course was uneventful and he was discharged in 3 weeks. The literature of the subclavian arterial aneurysm was briefly reviewed.     

Total arch replacement for intrathoracic left subclavian artery aneurysm; report of a case

A 65-year-old man with left subclavian artery aneurysm, detected by enhanced computed tomography (CT), was referred to our hospital. The CT revealed intrathoracic left subclavian artery aneurysm (maximum diameter, 5 cm) at the takeoff of the aortic arch. Surgery was indicated considering the risks of rupture and embolism. The aneurysm was exposed through median sternotomy. Cardiopulmonary bypass was established with cannulation of the right axillary artery, left femoral artery, superior vena cava (SVC), and inferior vena cava (IVC). Circulatory arrest and isolated cerebral perfusion were achieved at a core temperature of 23 degrees C. Total arch replacement was performed using a 26 mm 4-branched Triplex graft, and the left subclavian artery was reconstructed by branch-left axillary artery bypass. The postoperative course was uneventful. He was discharged on the 22nd postoperative day.     

A case report of ruptured aneurysm of the sinus Valsalva resulted in tricuspid valve endocarditis]

A case of a 42-year-old man with ruptured aneurysm of the sinus Valsalva resulted in tricuspid valve endocarditis was reported. The aneurysm originating from the right sinus Valsalva ruptured into the right atrium, which caused tricuspid valve endocarditis. The aneurysm was closed through right atrial approach. A part of the septal leaflet of tricuspid valve including vegetation was resected and repaired.     

A case of thoracoabdominal aortic aneurysm ruptured into the right extrapleural cavity

A 63-year-old man of thoracoabdominal aortic aneurysm was transferred to our department. Thoracic and abdominal enhanced CT scan revealed a Crawford's type I A thoracoabdominal aortic aneurysm ruptured into the right extrapleural and retroperitoneal spaces. Without any more additional examination, graft replacement and reconstruction of a lower intercostal artery were performed with an aid of femoro-femoral bypass. Although the postoperative course was complicated by hypertension, hypoventilation and liver dysfunction, the patient recovered from the operation and 10 months later he is leading an almost normal life. Since emergency operation of thoracoabdominal aneurysm is the most courageous challenge because of the difficulties of exposure and visceral organ protection against ischemic, there have been only nine cases with successful surgery in Japan. Now we actively reconstruct lower intercostal and lumbar arteries to prevent spinal cord ischemia without ESCP monitoring in emergency cases.     

Surgical repair of a left subclavian artery aneurysm causing stenosis of a left internal mammary graft-a case report

Subclavian artery aneurysms are extremely rare, accounting for approximately 0.1% of peripheral artery aneurysms. We present a case of a proximal left subclavian arterial aneurysm in a patient status post previous coronary artery bypass grafting; the aneurysm was complicated by involvement of the left internal mammary artery that had been previously utilized to revascularize the left anterior descending artery. Ostial stenosis of the internal mammary artery secondary to the aneurysm was present. Simultaneous reoperative coronary bypass surgery and repair of the left subclavian aneurysm was performed, with a good result. This is the second case reported in the literature of concomitant subclavian artery aneurysm repair and coronary revascularization.     

Congenital right subclavian artery aneurysm: a case report

Aneurysms of the subclavian artery are unusual. The most common causes are atherosclerosis and trauma. We report one case of an elongated and tortuous right subclavian artery with an aneurysm involving the origin of the right vertebral artery. The patient underwent resection of the lesion with an end-to-end anastomosis of the subclavian artery and implantation of the right vertebral artery into the right common carotid artery. Results were consistent with a rare congenital subclavian aneurysm.     

颈内动脉瘤合并锁骨下动脉瘤1例

患者女,45岁,7天前突然头痛、头晕伴恶心呕吐,既往健康。查体：生命体征平稳。头颅CT平扫双侧裂池、前纵裂略高密度影。DSA（图1～4）：右侧颈内动脉前床突段向后侧方囊状膨突动脉瘤10mm×9mm,可见附壁血栓,外缘不规则。左侧锁骨下动脉、椎动脉开口远端可见向上前方囊状膨突动脉瘤7．0mm×4．2mm,外缘光滑。     

Mitral subannular left ventricular aneurysm. A case report

A mitral subannular left ventricular aneurysm in an Ovambo man is described. This condition should be suspected in patients of negroid descent presenting with mitral incompetence and a localised bulge on the left heart border on chest radiography. Mitral and aortic subannular aneurysms are discussed, including the diagnostic use of ECG gated cardiac blood pool imaging.