Healed dissection confused with temporal arteritis. Extensive neovascularization--a distinguishing feature

A diagnosis of healed arteritis was made on a right temporal artery biopsy from a 65-year-old woman. She died shortly thereafter despite prednisone therapy. At autopsy, a healing dissection of the entire aorta with extension into the right innominate, right subclavian, right common carotid, right renal, and both iliac arteries was found. There was no underlying aortitis. Review of the temporal artery biopsy showed numerous thick-walled proliferated capillaries in the media of the temporal artery. The stroma was scant and the capillaries were surrounded by endothelial cells. The extensive medial neovascularization represented healed aortic dissection that had extended into the right common carotid, right external carotid, and the right superficial temporal artery. The histologic lesion in dissection is distinctive and should not be confused with temporal arteritis.     

Surgical treatment for innominate artery aneurysm with a coronary pulmonary artery fistula: a case report.

A 50-year-old woman complained of hoarseness and chest X-ray demonstrated a widening of the superior mediastinum. Computed tomography scanning and aortography demonstrated aneurysmal dilatation at the innominate artery. Coronary arteriography showed a coronary pulmonary artery fistula originating from the left anterior descending artery. The surgical procedure was prosthetic bifurcated bypass grafting from the ascending aorta to the right common carotid artery and right subclavian artery. During the period of innominate artery occlusion, the patient was cooled to 25 degrees C with selective cerebroperfusion and circulatory arrest. Pathologic diagnosis of the specimen was that of a true aneurysm with atherosclerotic plaque and calcification. The coronary pulmonary artery fistula was closed inside the pulmonary artery. There were no signs of neurologic deficit noted. Innominate artery aneurysm is uncommon and the surgical approach varies in each case. A coronary artery fistula is also an uncommon congenital malformation but has been recognized more often with the improvement in diagnostic techniques such as selective coronary arteriography. We performed successful surgical treatment for a rare case of innominate artery aneurysm with a coronary pulmonary artery fistula.     

Resection of giant coronary artery aneurysms in a Takayasu's arteritis patient

Takayasu's arteritis is a chronic vasculitis of unknown cause. Coronary arteries are affected in approximately 10% of cases with aneurysm formation being extremely rare. Coronary aneurysms (not related to Takayasu's arteritis) have been surgically treated with aneurysm resection and coronary bypass. We describe the case of a young woman found to have giant coronary artery aneurysms. She underwent resection of the aneurysms and short segment saphenous vein bypass to the right and left coronary arteries. In reviewing the literature, this seems to be the first case of Takayasu's arteritis related to coronary artery aneurysm treated surgically with a good result.     

A case of traumatic aneurysm of innominate artery with occlusion of right subclavian artery

A 42-year-old woman with history of chest blunt trauma from an automobile accident 250 days earlier had suffered easy fatigability of the right upper extremity. She had difference of blood pressure between upper extremities, 94/60 mmHg in the right and 126/70 mmHg in the left. Chest CT showed dilation of the innominate artery which compressed the trachea. Aortography showed an aneurysm of the innominate artery and occlusion of the right subclavian artery at its origin. The aneurysm of the innominate artery was resected and replaced with a 6 mm Dacron graft with aid of the external shunt. The right subclavian artery was also reconstructed with same graft. The aneurysm of the innominate artery should be suspected as a rare complication in blunt trauma of the chest.     

Single stage multiple stenting in Takayasu's arteritis. Case report

A 32-year-old Filipino female presented with Takayasu's arteritis manifesting as an abrupt onset of syncope. Physical examination revealed diminished consciousness, right hemiparesis, and a large discrepancy in blood pressure between the upper and lower extremities. Magnetic resonance imaging revealed cerebral infarcts in the left basal ganglia and the left temporal lobe. Angiography revealed complete occlusion of the left common carotid artery and severe stenosis of the brachiocephalic artery, the right common carotid artery, and the left subclavian artery. Based on the clinical examination and studies, the diagnosis was Takayasu's arteritis, type I. The patient's condition stabilized after 2 months of prednisone and anti-platelet therapy. Single stage multiple stenting in the brachiocephalic artery, the right common carotid artery, and the left subclavian artery was then performed using high pressure inflation to dilate the arteries due to the remarkably rigid lesions that resulted from extensive and diffuse fibrosis throughout the vessel walls. Although a small intimal flap occurred during inflation of the left subclavian artery, re-dilation was possible with the stent. Even with evidence of notable recovery in blood pressure and cerebral blood flow, no further neurological improvement was observed. In view of the favorable short- and intermediate-term results, single stage multiple stenting may be the optimum treatment option for first-line stent-supported angioplasty in patients with Takayasu's arteritis.     

Composite graft replacement after aortic valvuloplasty in Takayasu arteritis

A 24-year-old woman had undergone valvuloplasty of the aortic valve and external reinforcement of an aneurysm of the ascending aorta during the active phase of Takayasu arteritis 1 year prior to admission to our hospital. On examination, she was diagnosed as having a large false aneurysm of the ascending aorta with annuloaortic ectasia and severe aortic regurgitation, bilateral common carotid artery aneurysms with a left internal carotid artery saccular aneurysm, and bilateral subclavian artery and right vertebral artery obstructions due to Takayasu arteritis. Because of the risk of rupture, surgical intervention was carried out in spite of the fact that aortitis was in the active phase.     

Single-stage repair for ascending aortic aneurysm,artery stenosis and occlusion of neck vessels caused by Takayasu arteritis

Takayasu arteritis results in a variety of vascular symptoms, and there are some cases in which progressive vascular lesions require surgical intervention. We present a case with ascending aortic aneurysm, right common carotid artery stenosis, left common carotid artery occlusion and left subclavian artery stenosis caused by Takayasu arteritis that was successfully treated with total arch replacement and ascending aorta to right internal carotid artery bypass.     

Surgical treatment of ruptured aneurysms of the innominate artery

The cases of 3 patients with an aneurysm of the innominate artery treated surgically are reported. The clinical manifestations were different, and the surgical procedures employed also varied. In 1 patient, the neck of the aneurysm was isolated and clamped near the aortic arch. It was closed, and a graft was interposed between the ascending aorta and the right carotid and subclavian arteries. In the second, the aneurysm was resected under cardiopulmonary bypass, deep hypothermia, and total circulatory arrest. The neck was closed with a large Teflon patch, and a tube graft was interposed between the ascending aorta and the right carotid artery. In the third, a graft was interposed between both carotid arteries; conventional cardiopulmonary bypass was instituted, and the aorta was clamped between the innominate and the left carotid arteries. The neck of the aneurysm was closed, and a graft was interposed between the ascending aorta and the right carotid and subclavian arteries. All patients had an excellent postoperative course. Our comments regarding the clinical and surgical aspects of this condition are based on the present experience and reports in the literature.     

Combined open and endovascular treatment of a right subclavian artery aneurysm: a case report

A 69-year-old man with previous ascending aortic repair combined with valve replacement for an ascending aortic aneurysm presented with a type 2 thoracoabdominal aneurysm and a 4.4-cm aneurysm of the right subclavian artery. Because of the anatomic location of the aneurysm and his previous operation, an innominate to carotid artery stent graft and a carotid-subclavian bypass and vertebral artery bypass were performed. Postoperative computed tomographic angiography confirmed good flow in the right carotid and vertebral artery, and the patient recovered without complication.     

Extraanatomical reconstruction for bilateral intrathoracic subclavian artery aneurysms

Successful extraanatomical repair of bilateral intrathoracic arteriosclerotic subclavian artery aneurysms is reported. Rupture of the left subclavian aneurysm required emergency thoracotomy for proximal and distal ligation. The right subclavian aneurysm was repaired electively. Because of constraints resulting from the arterial anatomy (origin of aneurysm at innominate artery bifurcation), prior operation (coronary artery bypass grafting and repair of aneurysm of the sinus of Valsalva), and the patient's occupation (young, employed craftsman with dominant right hand), an extraanatomical reconstruction was devised to exclude the aneurysm and revascularize the head and arm. The reconstruction consisted of an external ilioaxillary Gore-Tex bypass graft in conjunction with an end-to-end distal subclavian to distal common carotid Gore-Tex graft. This is believed to represent the first reported successful repair of bilateral intrathoracic arteriosclerotic subclavian aneurysms, and the first application of this extraanatomical reconstruction.     

Surgical Repair of an Aneurysm of the Innominate Artery with Fistulization into the Trachea

This report describes a 43-year-old patient presenting with an aneurysm located at the junction between the innominate artery and aorta, with spontaneous fistulization into the trachea. Emergency treatment of this unusually located lesion was undertaken to prevent intratracheal rupture. After ligation of the innominate artery, right common carotid artery, and right subclavian artery due to the risk of infection, the tracheal fistula was treated by direct closure and exclusion using an autologous pericardial flap. The procedure was performed under extracorporeal circulation and circulatory arrest with profound hypothermia.     

Cerebral embolic stroke and arm ischemia in a teenager with arterial thoracic outlet syndrome: a case report

A rare presentation of arterial thoracic outlet syndrome (TOS) is described in a young woman. Arterial TOS caused by a cervical rib produced acute upper extremity ischemia due to subclavian artery aneurysm formation. Clinical presentation also included left hemiparesis caused by right subclavian artery thrombosis and retrograde embolization of thrombus via the common carotid artery to the right middle cerebral artery distribution. Surgical repair of the subclavian artery was performed, but permanent neurologic deficit remained. Acute thrombosis of the right subclavian artery can produce cerebrovascular complication. The assessment of such risk in patients with arterial TOS is warranted and the arterial lesion corrected surgically.     

Subclavian artery aneurysm in association with congenital absence of ipsilateral internal carotid artery

Aneurysms of the subclavian artery are rare. Similarly, congenital absence of the internal carotid artery is an extremely rare vascular anomaly. In this report, we discuss the case of a 54 year-old woman with an unusual aneurysm of the right subclavian artery in association with congenital absence of the right internal carotid artery. The aneurysm was successfully surgically repaired. On the basis of the appearance of the aneurysm and the absence of known atherosclerotic risk factors in this patient, it is hypothesized that the aneurysm is, in fact, congenital and related to anomalous development of the embryonic aortic arch branches.     

Extracranial carotid aneurysm in Takayasu's arteritis.

Extracranial carotid aneurysm caused by Takayasu's arteritis is extremely rare. We have experienced six cases of extracranial carotid aneurysm among 106 cases of Takayasu's arteritis that were treated surgically in the past 50 years. We herein review these cases and discuss the surgical indications and postoperative course of this rare disease. We report original observations about extracranial carotid aneurysm in Takayasu's arteritis.     

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??Intracranial ischemia caused by type ?? Takayasu's arteritis : A clinical analysis of 14 cases LIU Yi-ren, GU Yong-quan, GUO Lian-rui, et al. Department of Vascular Surgery, Xuanwu Hospital, Capital University of Medical Sciences, Beijing 100053, China
Corresponding author??GU Yong-quan??E-mail??15901598209@163.com
Abstract Objective To explore the choice and effect of vascular bypass treatment for intracranial ischemia caused by Takayasu's arteritis. Methods The clinical data of 14 cases of intracranial ischemia cased by type I Takayasu's arteritis admitted from 2005 to 2015 in Department of Vasculary Surgery, Xuanwu Hospital,Capital University of Medical Sciences were analyzed retrospectively. All patients received vascular bypass. Five cases of unilateral carotid artery occlusion with incomplete willis ring were performed ascending aorta to uiilateral carotid artery bypass. Five cases of bilateral carotid artery occlusion with complete willis ring were performed ascending aorta to unilateral carotid artery bypass. One case of bilateral carotid artery and subclavian artery occlusion with complete willis ring was performed ascending aorta to bilateral axillary artery bypass. Three cases of unilateral carotid artery and bilateral subclavian artery occlusion with complete willis ring were performed ascending aorta to bilateral axillary artery bypass. Results Vascular bypass treatment were completed in 14 cases and 18 artificial blood vessels were used. Postoperative pulmonary infection and pleural effusion occured in 1 case, and thrombosis was found in artificial blood vessels in 1 case after operation. Ischemic symptoms was significantly improved in 10 cases. Three cases get better. Symptoms were not improved in 1 case. The total effective rate of group was 92.9%(13/14), and the total patency of graft was 94.4%(17/18). All the cases were followed up 5 to 115 months. One died of cerebral hemorrhage after 5 months. Artificial vascular occlusion occurred in 3 cases in the 6th, 66th and 79th month respectively after operation. Operation kept other blood vessels pristine and the total patency was 81.3% (13/16). Conclusion The willis's circle will be reference for the operative choice of vascular bypass treatment for intracranial ischemia caused by type I Takayasu's arteritis.     

Innominate artery aneurysm: axial reconstruction via a cervical approach

True aneurysms of the innominate artery are rare. Successful axial reconstruction in the past has required a combined cervical and transthoracic approach with placement of a prosthetic graft. We describe herein the occurrence of an innominate artery aneurysm that extended to and involved the proximal common carotid artery and subclavian artery in a 63-year-old woman. The patient presented with thomboembolic sequelae in her fingertips and had a pulseless upper extremity. Successful aneurysmectomy and axial reconstruction with a bifurcated graft was achieved by using cervical exposure alone. A subsequent staged revascularization of the upper extremity was successfully accomplished with a brachial to radial artery bypass and ulnar artery transposition.     

Subclavian steal syndrome and flow-related aneurysm. Another reason to treat.

A 48-year-old woman presented with a symptomatic right subclavian steal syndrome due to proximal subclavian artery stenosis. Anatomically the innominate artery was absent. Collateral circulation followed the vertebro-vertebral pathway with reversal of blood flow in the ipsilateral vertebral artery. There was also multiple dilated intervertebral collaterals and an associated saccular aneurysm on one of them. Surgical carotid-subclavian transposition permitted relief of clinical symptoms, disappearance of collateral circulation and subtotal regression of the aneurysm. This spontaneous evolution confirmed the role of high-flow in the pathogenesis of some aneurysms and the habitually good prognosis of flow-related aneurysms with correction of the cause. Arteriography still appears essential in diagnosis, pretherapeutic assessment and sometimes post-treatment evaluation in subclavian steal syndrome.     

An unusual combination of cardiovascular surgical disorders

A 53-year-year-old man presented with aortic regurgitation, subvalvular and supravalvular aortic stenoses, and aneurysms involving the ascending aorta, the arch, and the innominate, right subclavian, and left common carotid arteries. Surgery consisted of resection of the obstructive lesions, replacement of the aortic valve, graft replacement of the ascending aorta, and the arch resection of innominate and subclavian artery aneurysms and reconstruction with a side limb to which the right carotid artery was anastomosed. The patient has remained asymptomatic with full employment.     

Giant pseudoaneurysm of the extracranial vertebral artery successfully treated using intraoperative balloon catheters.

Traumatic pseudoaneurysms of the extracranial vertebral artery rarely occur, because of its deeply protected anatomical location. Because the direct surgical approach has resulted in high morbidity and mortality rates, ligation of the vertebral artery has been adopted, but this can cause an ischemia in the vertebrobasilar system. We report the case of a 73-year-old woman with a huge pseudoaneurysm of the right vertebral artery that occurred after attempted placement of a cardiac pacemaker. The aneurysm was 7 x 7 x 5 cm in size and its neck was situated just distal to the right subclavian artery. Direct surgical repair of the injured vessel and removal of the aneurysm were successfully performed using balloon catheters placed intraoperatively in both the innominate artery and the right vertebral artery.     

Fulminant development of mega-aorta due to Takayasu's arteritis: case report and review of the literature

Takayasu's arteritis is a rare inflammatory arteriopathy characterized by segmental involvement of the aorta, its major branches, and, occasionally, the pulmonary arteries. Arterial inflammation generally results in occlusion, but Takayasu's arteritis occasionally presents as aneurysm formation. Takayasu's arteritis generally afflicts young women and is most often characterized by an acute episode of systemic illness and neurologic symptoms secondary to stenoses of the carotid and vertebral circulation. We report an unusual case of Takayasu's arteritis in a 43-year-old man who presented with severe back pain and provide a brief review of the literature.