A Case of Atherosclerotic Aneurysm of the Right Subclavian Artery with the Right Axillary Arterial Stenosis and Enlargement of the Ascending Aorta

Iida, Mitsuru; Hata, Hiroyuki; Kimura, Haruka

doi:10.5761/atcs.cr.10.01607

Cited by 4 publications

(1 citation statement)

References 10 publications

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“…3 The most common causes of subclavian artery aneurysm are atherosclerosis, followed by infection (mycotic, syphilitic, and tuberculosis), thoracic outlet syndrome, trauma, Marfan syndrome, Ehlers-Danlos syndrome, neurofibromatosis, and congenital anomalies (Turner syndrome). 4 These aneurysms range from incidentally discovered asymptomatic disease to symptomatic life-threatening vascular emergencies. Symptoms likely develop because of compression on adjacent structures and include brachial plexus irritation, Horner syndrome, dysphagia, hemoptysis, chest pain, and upper extremity deep vein thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Giant Subclavian Artery Aneurysm

2014

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A 37-year-old male patient presented with dyspnea, chest pain, and episodic dizziness to the point of near syncope on exertion. The patient reported that he was known to have a murmur since he was 2 years old. On clinical examination, systolic and diastolic murmurs could be auscultated. There was no family history of significant cardiac disease, aneurysm, or premature sudden death. Physical examination revealed a 4/6 systolic ejection murmur that radiated to the right greater than left carotid and a 2/6 diastolic murmur heard at the upper sternal borders accentuated with forced exhalation. The remainder of his clinical examination and his laboratory tests were unremarkable.The workup included a chest X-ray, echocardiogram, computed tomographic angiography, and aneurysmal survey which did not show any evidence of additional aneurysmal disease elsewhere in the body. The echocardiogram revealed severe aortic stenosis with a gradient of 54 mm Hg and the valve velocity of 3.7 m/sec, severe aortic insufficiency, a bicuspid aortic valve, severe left ventricular hypertrophy, left atrial dilatation, and an enlarged ascending aorta. CT imaging showed a bicuspid aortic valve with thickened, fused right and noncoronary cusps in addition to a nodular density immediately distal to the cusps. The ascending aorta was noted to be enlarged to 4.1 cm in diameter. The aortic dilatation continued into the arch. The left subclavian artery was also dilated at the takeoff from the aorta and measured 4.2 cm at its origin (►Figs. 1 and 2). The right brachiocephalic artery was abnormal and measured 2.3 cm in its proximal diameter (►Figs. 3 and 4). The left vertebral artery took off from the dilated left subclavian artery and was smaller in caliber compared with the right vertebral artery. Coronary imaging disclosed an absent left circumflex with a diagonal vessel supplying the lateral wall, with no significant stenosis or calcifications was noted.A two-stage procedure was undertaken. The aortic valve and ascending aorta were addressed first. Intraoperative transesophageal echocardiography confirmed the findings noted in preoperative echocardiography. The ascending aorta was noted to be very small, measuring 20 mm at the level of the sinotubular junction, and exceptionally thin walled. The aorta was opened longitudinally and transected above the coronary arteries allowing visualization of the markedly deformed bicuspid aortic valve and annular distortion. There was a 2 cm nodular atheroma originating in the aortic valve and attached to the aortic wall; the valve was nearly unicuspid on direct inspection. The abnormal leaflets were removed, the annulus debrided, and a St. Four weeks later, the patient was taken back to the operating room to address the left subclavian artery aneurysm. Intraoperative transesophageal echocardiography revealed a competent mechanical aortic valve with no abnormalities. A left thoracotomy was performed and the Keywords ► subclavian artery aneurysm ► subclavian ► aneurysm ► bicuspid aortic valve AbstractWe report...

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Section: Discussionmentioning

confidence: 99%

Giant Subclavian Artery Aneurysm

2014

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Isolated aneurysm of the proximal right subclavian artery treated with consideration toward cerebral circulation and vasculature

Nonaka

Nakatsuka

Okada

et al. 2012

Gen Thorac Cardiovasc Surg

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A 65-year-old man with an isolated aneurysm of the proximal right subclavian artery (SCA) (diameter, 50 mm) was successfully treated with a deliberate surgical strategy described here. Because of the occluded left vertebral artery (VA) and poor development of the circle of Willis, the distal portion of the right SCA was bypassed from the ascending aorta before resecting the aneurysm in order to maintain blood flow to the brain through the right VA. Consequently, the patient recovered without neurological complications. We conclude that conventional surgery remains effective for complex vascular diseases even in the era of advanced endovascular surgeries.

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Giant Subclavian Artery Aneurysm Associated with Airway Stenosis

Nakayama¹,

Sakamoto²,

Itô³

2013

J. J. C. V. S.

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A 65-year-old man presented to our hospital with a chief complaint of hoarseness. Chest radiography and computed tomography detected a right subclavian artery aneurysm. The aneurysm had a maximum diameter of 85 mm, and was associated with a mural thrombus and displacement of the trachea to the left, which led to airway stenosis. In case ventilatory insufficiency developed during anesthesia induction, an extracorporeal membrane oxygenator was prepared, followed by administration of anesthesia. Careful administration of anesthesia allowed for anesthesia management without the extracorporeal membrane oxygenator. We approached the periphery and the proximal portion of the aneurysm through a right subclavicular incision and partial median sternotomy, respectively. After excision of the aneurysm, we performed EPTFE prosthesis implantation. The patientʼs postoperative course was uneventful, which led to postoperative improvement of the airway stenosis. The combination of a right subclavicular incision and partial median sternotomy is useful for the surgical treatment of large subclavian artery aneurysms such as the one in this case. Moreover, careful anesthesia management after close consultation with anesthesiologists is important for patients who exhibit preoperative airway stenosis.

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A Case of Atherosclerotic Aneurysm of the Right Subclavian Artery with the Right Axillary Arterial Stenosis and Enlargement of the Ascending Aorta

Cited by 4 publications

References 10 publications

Giant Subclavian Artery Aneurysm

Giant Subclavian Artery Aneurysm

Isolated aneurysm of the proximal right subclavian artery treated with consideration toward cerebral circulation and vasculature

Giant Subclavian Artery Aneurysm Associated with Airway Stenosis

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