A Subclavian artery aneurysm associated with aortitis syndrome

We performed surgery on a 61-year-old woman who had increasingly severe right shoulder pain and paresthesia in her right upper extremity as a result of a large right subclavian artery aneurysm. She had suffered from aortitis syndrome for 10 years for which she was treated with steroids and had multiple arterial lesions, including bilateral subclavian artery aneurysms, abdominal aortic aneurysm and obstruction of bilateral superficial femoral arteries. The right subclavian artery aneurysm measured 4 cm in diameter and rupture appeared imminent, prompting surgical therapy. Via the supra-clavicular incision approach and additional partial sternotomy, the aneurysm was excluded and the brachiocephalic to right axillar arterial bypass was set up using an extended polytetrafluoroethylene graft. The patient recovered without complications and a subclavian artery aneurysm demonstrated by computed tomography was thrombosed 1 month after surgery. In conclusion, we recommend the exclusion technique to treat subclavian artery aneurysms in cases in which aneurysmectomy is likely to injure adjacent veins and nerves.     

A successful surgical treatment of ascending aortic aneurysm, left common carotid artery aneurysm and left subclavian artery obstruction due to aortitis syndrome in active phase]

A 24-year-old female was admitted complaining of coldness of left upper extremity and pulsating tumor of the neck. She was diagnosed as ascending aortic aneurysm, left common carotid artery aneurysm and left subclavian artery obstruction due to aortitis syndrome on examinations. Although steroid treatment appeared to be effective in controlling inflammatory reaction, the left common carotid artery aneurysm increased in size and severe neck pain started. The risk of rupture was feared, and surgical intervention was carried out in spite of aortitis in active phase. The patient underwent surgery where aneurysmectomy and graft replacement for ascending aortic aneurysm, aneurysmectomy and graft replacement using autogenous saphenous vein for left common carotid artery aneurysm and bypass grafting for left subclavian artery obstruction were performed. The histology of resected specimens of aortic wall showed active aortitis. The postoperative course was uneventful and the patient was discharged on steroid.     

Ruptured cerebral aneurysm associated with aortitis syndrome: a case report

In rare occasions, patients with aortitis syndrome have cerebral aneurysms and only seven cases have been reported so far. A case of aortitis syndrome complicated with basilar bifurcation aneurysm is reported. A 58-year-old woman, who had been hypertensive for 20 years and was diagnosed as pulseless disease 10 years ago, suddenly had severe headache and became unconscious on Feb. 17, 1983. Spinal tap performed 3 days after the onset demonstrated bloody cerebrospinal fluid. She was referred to our clinic 8 days following the ictus of subarachnoid hemorrhage. On admission, she was drowsy and had headache, neck stiffness, disorientation and left hemiparesis. Pulsation of the left common carotid and left radial artery was unpalpable. Angiography through the intraaortic catheter revealed occlusion of the left common and left subclavian arteries at their origin, confirming aortitis syndrome. Through the patent right vertebral artery, basilar artery was visualized and an aneurysm at the basilar bifurcation was noted. Seven cases reported in the literature were reviewed.     

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。     

Surgical approach to left subclavian artery aneurysm in Marfan syndrome

We present a case of left subclavian artery aneurysm in a 48-year-old man with Marfan syndrome. Aneurysmectomy and interposition with an artificial graft were successfully performed through an infraclavicular incision by dividing the clavicle at its midshaft. The clavicle bone was reconstructed with a steel plate, and the postoperative course was uneventful. Because the arterial wall is fragile in cases of connective tissue disorders such as Marfan syndrome, our surgical approach was considered to be helpful for gentle maneuvering in an adequate operative field.     

Surgical treatment of aortic arch aneurysm associated with the aberrant right subclavian artery

A 64-year-old man, who had an aneurysm of aortic arch associated with the aberrant right subclavian artery, was treated successfully. He was pointed out to have an aneurysm of aortic arch three years ago. Three years later angiograms and computed tomography revealed that it became larger compared with the initial finding. He underwent a replacement of the aortic arch using a woven Dacron graft under open distal method. Aberrant subclavian artery was not involved in the aneurysm. But because the left subclavian artery was involved in it, a woven Dacron graft was interposed between the ascending aorta and left subclavian artery. Postoperative course was uneventful and there were no complications.     

Raeder's syndrome associated with intracranial internal carotid artery aneurysm

Raeder's syndrome consists of oculosympathetic paresis and ipsilateral facial pain, with variable involvement of the trigeminal and oculomotor nerves. A 63-year-old woman experienced severe facial pain, a partial Horner's syndrome, and restriction of ocular movements on the left side. A left carotid angiogram disclosed a giant aneurysm of the cavernous portion of the internal carotid artery. This is the third reported case of Raeder's syndrome due to aneurysm of the intracranial internal carotid artery. Her facial pain was relieved by carotid ligation, and serial computed tomographic scans showed decrease of aneurysmal size.     

Aneurysm of the left subclavian artery associated with Turner's syndrome. Successful surgical treatment

An unusual case of a 38-year-old woman with Turner's syndrome associated with aneurysmal dilation of the left subclavian artery is presented. Aortography revealed a fusiform aneurysm in the proximal segment of the left subclavian artery, which was as long as 6 cm. The diagnosis of Turner's syndrome was postoperatively confirmed by chromosomal study, which showed 45X0. The aneurysm was successfully removed and reconstruction was done by interposition of a woven Dacron graft, 8 mm in diameter and 6 cm in length, between the thoracic aorta and subclavian artery just proximal to the thoracic outlet. Microscopic findings of the resected tissue of the subclavian artery revealed deposition of acid mucopolysaccharide in the intima and media.     

Atherosclerotic aneurysm of the subclavian artery

Aneurysm of the subclavian artery is unusual and may have several causes. Cases of atherosclerotic origin have been very uncommon, specially if the aneurysm involves normal subclavian arteries. The authors report a case with these characteristics: a 62-year-old female had noted a tumor in the right supraclavicular fossa for thirty years. Angiographically, it proved to be an aneurysm. She was operated on, and a Dacron tubular prosthesis of 6 mm was implanted. The anatomo-pathologic study of the aneurysm showed typical atherosclerotic changes.     

Atherosclerotic aneurysm of the subclavian artery

An aneurysm of the right subclavian artery, a rare pathologic entity, is described. The presence of a pulsatile mass in the cervical region should always suggest the diagnosis, which is best confirmed by arteriography. Approaching the lesion by partial sternotomy extending to the third intercostal space gives excellent exposure. The aneurysm should be resected and vascular continuity re-established by the use of a synthetic prosthesis.     

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 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.     

A case of coronary artery bypass for bilateral coronary ostial stenosis in aortitis syndrome with occlusion of bilateral subclavian arteries]

A 52-year-old female with bilateral coronary ostial stenosis in aortitis syndrome underwent CABG. Vein grafts were used instead of arterial grafts, because of the occlusion of bilateral subclavian arteries. Proximal anastomosis of the grafts was performed after oval stomas larger than usual were created on the aortic wall to prevent late graft occlusion due to intimal proliferation of the aorta. On postoperative CAG, all grafts to RCA, LAD and Cx were patent. The patient left the hospital 3 weeks after surgery. We believe that CABG is preferable to the transaortic endarterectomy in the surgical treatment for coronary ostial stenosis associated with aortitis syndrome, because of the prevalence of technical difficulty and postoperative morbidity in the latter.