分期介入治疗主动脉缩窄合并右锁骨下动脉瘤1例

主动脉缩窄(CoA)是指主动脉局限狭窄,管腔缩小,造成血流量减少.主动脉缩窄可以单独出现,也可以合并二叶式主动脉瓣、室间隔缺损、动脉导管未闭、大动脉转位等病变.主动脉狭窄合并右锁骨下动脉瘤非常罕见,本文报导一例主动脉缩窄合并右锁骨下动脉及降主动脉瘤,一期应用定制的Armada 35球囊扩张导管及覆膜支架治疗主动脉狭窄,...     

Surgical treatment for thoracic aortic aneurysm with aberrant right subclavian artery

We present two operative cases of thoracic aortic aneurysm combined with aberrant right subclavian artery (ARSA). Case 1 was a 71-year-old man with a fusiform-type arch aneurysm. He underwent total aortic arch replacement to reconstruct all 4 arch branches. Case 2 was a 39-year-old man suffering from chronic DeBakey type IIIb dissection. He underwent total descending thoracic aortic replacement for the remaining ARSA. In both cases ARSA was diagnosed preoperatively by reconstructed three-dimensional computed tomography (3D-CT). Both patients followed uneventful postoperative courses with excellent results. 3D-CT is helpful for precise planning of surgical strategy in such cases.     

Surgical treatment for thoracic aortic aneurysm with aberrant right subclavian artery

We present two operative cases of thoracic aortic aneurysm combined with aberrant right subclavian artery (ARSA). Case 1 was a 71-year-old man with a fusiform-type arch aneurysm. He underwent total aortic arch replacement to reconstruct all 4 arch branches. Case 2 was a 39-year-old man suffering from chronic DeBakey type IIIb dissection. He underwent total descending thoracic aortic replacement for the remaining ARSA. In both cases ARSA was diagnosed preoperatively by reconstructed three-dimensional computed tomography (3D-CT). Both patients followed uneventful postoperative courses with excellent results. 3D-CT is helpful for precise planning of surgical strategy in such cases.     

Acute aortic dissection involving an aberrant right subclavian artery

Although the aberrant right subclavian artery is the most common abnormality in aortic arch development, it is unusual to encounter this abnormality when repairing acute aortic dissection. We report a case of Stanford type A acute aortic dissection involving an aberrant right subclavian artery in a 45-year-old man. We used the elephant trunk procedure to surgically manage the intimal tear and aberrant right subclavian artery. This is, to our knowledge, the first report in Japan of surgical reconstruction of an aberrant right subclavian artery in conjunction with acute aortic dissection.     

An aberrant left subclavian artery aneurysm with right aortic arch: Report of a case

The case of a 41-year-old man who developed an aneurysm in his aberrant left subclavian artery is described. The patient had a right aortic arch. After a successful aortosubclavian artery bypass, symptoms due to brain ischemia disappeared. This is a very rare disease that is sometimes associated with an aortic anomaly, therefore the optimal therapeutic procedure need to be carefully selected, including the operative indications and approach.     

Surgery for aortic dissection involving an aberrant right subclavian artery

On diagnosis of Stanford type A acute aortic dissection with an aberrant right subclavian artery, emergency operation was performed. Aortic arch replacement was undertaken with additional ‘elephant trunk’ procedure to cover the entry site and decrease the blood flow through the false lumen. We consider this technique will become one of the effective procedures for acute aortic dissection involving an aberrant right subclavian artery.     

Revascularization of left subclavian artery for coronary subclavian steal syndrome

We have experienced 2 patients with coronary subclavian steal syndrome which progressed each to a different prognosis. Both cases received percutaneous transluminal angioplasty for subclavian artery stenosis after coronary artery bypass grafting. Although one case is doing well without any symptoms, the other case required axilloaxillary artery bypass grafting for the subclavian artery restenosis.     

A rare case of a blunt thoracic aortic injury in a patient with an aberrant right subclavian artery: A case report and literature review

IntroductionBlunt thoracic aortic injuries (BTAIs) are an uncommon traumatic injury that if not treated promptly, can result in death. We present the case of a BTAI with aberrant aortic anatomy.Presentation of caseA 60-year-old female was involved in a motor vehicle crash where she suffered significant polytrauma including a BTAI. She was also found to have an aberrant right subclavian artery originating from the aortic arch. Thoracic Endovascular Aortic Repair (TEVAR) with a right common carotid artery to right subclavian artery bypass was accomplished. She required three more vascular surgical interventions, two for persistent type II endoleak and the third for left upper extremity acute limb ischemia. She had a 2-month hospital course for her devastating injuries and was eventually discharged home. A follow-up CT angiogram showed a stable thoracic aortic arch stent.DiscussionBTAIs are uncommon in the trauma population. In our patient who had an aberrant right subclavian artery, further procedures were required in the form of a right common carotid artery to right subclavian artery bypass and embolizations to resolve endoleaks.ConclusionBlunt thoracic aortic injuries are life threatening and require urgent intervention. TEVAR is associated with better outcomes. An aberrant right subclavian artery originating from the aortic arch, distal to the left subclavian artery is an anatomic variant that adds significant complexity to TEVAR. TEVAR is still an option for repair of blunt thoracic aortic injuries despite anatomic variations as open repair still carries an increased risk of morbidity and mortality.     

Anaesthesia and the subclavian steal syndrome

Anaesthesia in two patients with subclavian steal syndrome is described. Both patients showed an interesting response to hyperventilation. The mechanism of this response and its implications for the anaesthetist are discussed.     

Symptomatic atherosclerotic stenotic disease of an aberrant right subclavian artery

Symptomatic atherosclerotic stenosis of an aberrant subclavian artery is exceedingly rare. Herein we describe a patient with this diagnosis who presented with arm claudication, and was treated with carotid-subclavian bypass.     

Kommerell’s diverticular rupture complicated by aberrant left subclavian artery and right aortic arch successfully treated surgically

We report a rare case of a rupture in Kommerell’s diverticulum in a 73-year-old woman with Edwards IIIB aberrant left subclavian artery (A-LSA) and right aortic arch. This case was further complicated by an inferior vena cava defect. We performed an emergency operation through a right posterolateral approach. The descending aorta was replaced and the Kommerell’s diverticulum was excised, followed by A-LSA reconstruction, performed under deep hypothermia with selective cerebral perfusion. We believe the prognosis was excellent.     

Cervical origin of right subclavian artery associated with tetralogy of Fallot

We present a case of an infant with tetralogy of Fallot with pulmonary atresia with an incidentally detected cervical origin of right subclavian artery. We highlight the importance of identifying this rare variation and the potential complications that may ensue.     

Tetralogy of Fallot,right aortic arch with isolated left subclavian artery: Rare synchronous triple occurrence!!!

We present a rare synchronous occurrence of tetralogy of Fallot, right aortic arch, and isolated left subclavian artery, highlighting potential clinical and therapeutic implications.     

Metastatic thyroid cancer manifesting as a mediastinal mass in a man with an aberrant right subclavian artery

We treated a case of thyroid cancer manifesting as a mediastinal mass, completely resecting it without difficulty despite a vascular anomaly. An asymptomatic 42-year-old woman was admitted with a mediastinal mass. Ten years earlier, she had undergone surgery for a thyroid tumor diagnosed as follicular adenoma. She also had an aberrent subclavian artery anomaly with a non-recurrent laryngeal nerve, radiographically recognized preoperatively. The mediastinal mass was completely resected through median sternotomy. Pathological examination showed the previous thyroid tumor had been follicular carcinoma, and that the mass was a mediastinal-node metastasis from the thyroid cancer. Preoperative recognition of the vascular anomaly was helpful in completing resection, in addition to safe, quick surgical procedures.     

Two-stage surgical and endovascular treatment of an aneurysmal aberrant right subclavian (Lusoria) artery

We report a case of a 75-year-old male patient with an asymptomatic aneurysm of an aberrant right subclavian artery (ARSA). Timely elective therapy of this entity is indicated due to the high risk of rupture. Because of the patient's reduced physical state, we performed an interdisciplinary endovascular aortic stent-grafting for the exclusion of the ARSA aneurysm. However, the proximal landing zone for the thoracic stent had to be chosen proximal to the origin of the left subclavian artery. Thus, 2 days before the endovascular procedure, a left-sided carotido-subclavian bypass was accomplished. The peri- and postoperative course was uneventful. The technical results in our patient were excellent, no leakage was visible so far.     

Hand muscle atrophy and digital ischemia as an unusual presentation of an occluded aberrant right subclavian artery: Endovascular or open approach?

INTRODUCTIONAn aberrant right subclavian artery (ARSA) or lusorian artery is one of the most common variations of the aortic arch. Although usually without symptoms, some ARSA's occasionally become symptomatic.PRESENTATION OF CASEA 51-year old woman presented with a painful right middle finger. Clinical examination showed thenar muscle hypotrophy and blue discoloration of the distal phalanx suggestive of embolization. Magnetic resonance angiography revealed a non-aneurysmal proximally occluded ARSA. A venous common carotid artery to subclavian artery bypass was combined with ARSA ligation proximal to the right vertebral artery.DISCUSSIONOcclusive symptomatic ARSA disease without aneurysmal dilatation is uncommon. Treatment may include bypass grafting by open surgery or angioplasty with stenting.CONCLUSIONTreatment for occlusive non-aneurysmal ARSA must be tailored to the individual. Whether an endovascular or surgical approach is preferred depends on localization of the lesion in relation to the esophagus and on the general condition of the patient.     

Abdominal and thoracic coarctation of the aorta with bilateral renal artery stenosis

A case of a young patient with mild coarctation of the thoracic and abdominal aorta associated with bilateral renal arterial stenosis is reported. The only clinical finding was hypertension. Surgical treatment with bilateral aortorenal venous bypass was successful.