有症状或动脉瘤性右锁骨下动脉异常修复的三种不同策略

IF 1.1 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
İsmail Selçuk, Hüseyin Sicim, Ümmühan Nehir Selçuk, Bülent Barış Güven, Ahmet Turan Yılmaz
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引用次数: 0

摘要

引言在本研究中,我们旨在提出三种不同的治疗症状性异常右锁骨下动脉(ARSA)手术的方法。方法我们确定了2016年1月至2020年12月期间连续11名接受有症状和/或动脉瘤性ARSA修复的成年患者。症状为吞咽困难(n=8)和呼吸困难+吞咽困难(n=3)。6例ARSA动脉瘤形成(平均直径4.2cm,范围2.8-6.3])。所有数据均进行回顾性分析。结果患者的中位年龄(7名女性/4名男性)为55岁(49-62岁)。前四名患者(36.4%)采用胸主动脉腔内修复术(TEVAR)和双侧颈动脉-锁骨下动脉搭桥术(CScBp)进行了混合修复。3名患者(27.2%)接受了开放性ARSA切除/结扎术,同时接受了左小后外侧开胸术(LMPLT)和右CScBp。最后4名患者(36.4%)接受了ARSA切除/结扎LMPLT和升主动脉-右锁骨下动脉搭桥术(UMS)。在接受TEVAR+双侧CScBp的四名患者中,有两名患者因持续性食管压迫而出现持续性吞咽困难。三名接受LMPLT+右侧CScBp的患者中有一名出现臂丛损伤。在接受UMS+LMPLT的四名患者中,有一名患者观察到单独胸腔积液治疗。结论在症状性和/或动脉瘤性ARSA的治疗方法中,手术和混合方法是可行的。对于如何管理这些患者,目前还没有达成共识。在我们的研究中,我们推荐UMS+LMPLT方法,因为解剖搭桥术并发症的风险较小,并且我们有更成功的手术结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Three Different Strategies for Repair of Symptomatic or Aneurysmatic Aberrant Right Subclavian Arteries.

Introduction: In this study, we aimed to present three different methods for symptomatic aberrant right subclavian artery (ARSA) surgery.

Methods: We identified 11 consecutive adult patients undergoing symptomatic and/or aneurysmal ARSA repair between January 2016 and December 2020. Symptoms were dysphagia (n=8) and dyspnea + dysphagia (n=3). Six patients had aneurysm formation of the ARSA (mean diameter of 4.2 cm [range 2.8 - 6.3]). All data were analyzed retrospectively.

Results: Median age of the patients (7 females/4 males) was 55 years (range 49 - 62). The first four patients (36.4%) underwent hybrid repair using thoracic endovascular aortic repair (TEVAR) and bilateral carotid-subclavian artery bypass (CScBp). Three patients (27.2%) were treated by open ARSA resection/ligation with left mini posterolateral thoracotomy (LMPLT) and right CScBp. And the last four patients (36.4%) underwent ARSA resection/ligation with LMPLT and ascending aorta-right subclavian artery bypass with upper mini sternotomy (UMS). Two of the four patients who underwent TEVAR + bilateral CScBp had continuing dysphagia cause of persistent esophageal compression. Brachial plexus injury developed in one of three patients who underwent LMPLT + right CScBp. Pleural effusion treated with thoracentesis alone was observed in one of four patients who underwent UMS + LMPLT.

Conclusion: Among the symptomatic and/or aneurysmal ARSA treatment approaches, surgical and hybrid methods are used. There is still no consensus on how to manage these patients. In our study, we recommend the UMS + LMPLT method, since the risk of complications with anatomical bypass is less, and we have more successful surgical results.

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来源期刊
Revista Brasileira De Cirurgia Cardiovascular
Revista Brasileira De Cirurgia Cardiovascular CARDIAC & CARDIOVASCULAR SYSTEMS-SURGERY
CiteScore
2.10
自引率
0.00%
发文量
176
审稿时长
20 weeks
期刊介绍: Brazilian Journal of Cardiovascular Surgery (BJCVS) is the official journal of the Brazilian Society of Cardiovascular Surgery (SBCCV). BJCVS is a bimonthly, peer-reviewed scientific journal, with regular circulation since 1986. BJCVS aims to record the scientific and innovation production in cardiovascular surgery and promote study, improvement and professional updating in the specialty. It has significant impact on cardiovascular surgery practice and related areas.
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