المؤلفون: Kaya, Murat¹ (AUTHOR) drmuratkaya85@gmail.com

المصدر: Archives of Gynecology & Obstetrics. Jul2024, Vol. 310 Issue 1, p129-133. 5p.

مصطلحات موضوعية: *SUBCLAVIAN artery, *FETAL abnormalities, *DIGEORGE syndrome, *FETAL heart, *DOPPLER ultrasonography

مستخلص: Purpose: This study aims to explore the correlation between fetal aberrant right subclavian artery (ARSA) and chromosomal disorders, with a specific focus on Down syndrome and DiGeorge syndrome. Methods: From November 2017 to February 2020, we conducted fetal anomaly screening and assessed the fetal heart in 8494 at our institution. The right subclavian artery tracing was assessed using Doppler ultrasonography following the 3-vessel and tracheal views (3VTV) in the fetal heart scan. Results: ARSA was found in 31 fetuses, which accounts for 0.36% of the total of 8494 fetuses. 96.8% of fetuses with ARSA were found to have normal chromosomal analysis. We identified only one case of trisomy 21 as the chromosomal condition present. In 80% of the identified ARSA, there were no additional associated findings. Conclusion: ARSA is a rare condition that often does not manifest any concomitant abnormalities. The majority of ARSA instances identified in the second trimester are euploid. If ARSA is the only sonographic finding during fetal anomaly screening and there are no maternal or laboratory risk factors, further evaluation with non-invasive diagnostics may be recommended. Non-invasive genetic testing may be used for additional investigation. [ABSTRACT FROM AUTHOR]

المؤلفون: Shi, Mengxiao¹ (AUTHOR), Fang, Hong¹ (AUTHOR), Wu, Ying¹ (AUTHOR), Li, Han² (AUTHOR), Sheng, Chong³ (AUTHOR), Li, Shuchun² (AUTHOR) leeshuchun@163.com, Zhou, Qing^1,2,3 (AUTHOR) zhouqing_penn@163.com

المصدر: Journal of Cardiothoracic Surgery. 6/28/2024, p1-9. 9p.

مصطلحات موضوعية: *SUBCLAVIAN artery, *ENDOVASCULAR aneurysm repair, *AORTIC dissection, *PLATELET aggregation inhibitors, *HEMORRHAGIC stroke

مستخلص: Background: Thoracic endovascular aortic repair (TEVAR) is a minimally invasive technique used to treat type B aortic dissections. Left subclavian artery (LSA) reconstruction is required when treating patients with involvement of LSA. The best antiplatelet therapy after LSA reconstruction is presently uncertain. Methods: This study retrospectively analyzed 245 type B aortic dissection patients who underwent left subclavian artery revascularization during TEVAR. Out of 245 patients, 159 (64.9%) were in the single antiplatelet therapy (SAPT) group, receiving only aspirin, and 86 (35.1%) were in the dual antiplatelet therapy (DAPT) group, receiving aspirin combined with clopidogrel. During the 6-month follow-up, primary endpoints included hemorrhagic events (general bleeding and hemorrhagic strokes), while secondary endpoints comprised ischemic events (left upper limb ischemia, ischemic stroke, and thrombotic events), as well as death and leakage events. Both univariate and multivariate Cox regression analyses were performed on hemorrhagic and ischemic events, with the Kaplan-Meier method used to generate the survival curve. Results: During the six-month follow-up, the incidence of hemorrhagic events in the DAPT group was higher (8.2% vs. 30.2%, P < 0.001). No significant differences were observed in ischemic events, death, or leakage events among the different antiplatelet treatment schemes. Multivariate Cox regression analysis showed that DAPT (HR: 2.22, 95% CI: 1.07–4.60, P = 0.032) and previous chronic conditions (HR:3.88, 95% CI: 1.24–12.14, P = 0.020) significantly affected the occurrence of hemorrhagic events. Chronic conditions in this study encompassed depression, vitiligo, and cholecystolithiasis. Carotid subclavian bypass (CSB) group (HR:0.29, 95% CI: 0.12–0.68, P = 0.004) and single-branched stent graft (SBSG) group (HR:0.26, 95% CI: 0.13–0.50, P < 0.001) had a lower rate of ischemic events than fenestration TEVAR (F-TEVAR). Survival analysis over 6 months revealed a lower risk of bleeding associated with SAPT during hemorrhagic events (P = 0.043). Conclusions: In type B aortic dissection patients undergoing LSA blood flow reconstruction after synchronous TEVAR, the bleeding risk significantly decreases with the SAPT regimen, and there is no apparent ischemic compensation within 6 months. Patients with previous chronic conditions have a higher risk of bleeding. The CSB group and SBSG group have less ischemic risk compared to F-TEVAR group. [ABSTRACT FROM AUTHOR]

المؤلفون: Chunxiao Li^1,2, Tao Deng^1,2 dengtao@ivpp.ac.cn, Yang Wang³, Fajun Sun⁴, Wolff, Burt³, Qigao Jiangzuo², Jiao Ma², Luda Xing^1,2, Jiao Fu^1,2, Ji Zhang^5,6 zhang_ji@hust.edu.cn, Shiqi Wang² wangshiqi@ivpp.ac.cn

المصدر: eLife. 6/20/2024, p1-22. 22p.

مصطلحات موضوعية: *MANDIBLE, *SUBCLAVIAN artery, *PROBOSCIDEA (Mammals), *ELEPHANTS, *IVORY, *CENOZOIC Era, *COEVOLUTION

مستخلص: The long-trunked elephantids underwent a significant evolutionary stage characterized by an exceptionally elongated mandible. The initial elongation and subsequent regression of the long mandible, along with its co-evolution with the trunk, present an intriguing issue that remains incompletely understood. Through comparative functional and eco-morphological investigations, as well as feeding preference analysis, we reconstructed the feeding behavior of major groups of longirostrine elephantiforms. In the Platybelodon clade, the rapid evolutionary changes observed in the narial region, strongly correlated with mandible and tusk characteristics, suggest a crucial evolutionary transition where feeding function shifted from the mandible to the trunk, allowing proboscideans to expand their niches to more open regions. This functional shift further resulted in elephantids relying solely on their trunks for feeding. Our research provides insights into how unique environmental pressures shape the extreme evolution of organs, particularly in large mammals that developed various peculiar adaptations during the late Cenozoic global cooling trends. [ABSTRACT FROM AUTHOR]

المؤلفون: Itagaki, Kota¹, Katahira, Shintaro¹ shinkatahira@med.tohoku.ac.jp, Hosoyama, Katsuhiro¹, Suzuki, Yusuke¹, Niikawa, Hiromichi², Otani, Masayuki¹, Taketomi, Ryuichi¹, Ito, Koki¹, Takahashi, Goro¹, Kumagai, Kiichiro¹, Okada, Yoshinori², Saiki, Yoshikatsu¹

المصدر: General Thoracic & Cardiovascular Surgery Cases. 6/20/2024, Vol. 3 Issue 1, p1-7. 7p.

مصطلحات موضوعية: *VASCULAR surgery, *SUBCLAVIAN artery, *ANEURYSM surgery, *JUGULAR vein, *AORTIC arch aneurysms

مستخلص: Background: The operative field in subclavian vessel surgery is limited by thoracic inlet and outlet structures. Although endovascular therapy for the subclavian artery could be an option, open repair management is occasionally required in cases of large aneurysms, infectious vasculopathy, and trauma. The transmanubrial osteomuscular sparing approach, commonly used in thoracic surgery area to resect superior sulcus tumors, is a simple and safe procedure providing an excellent view of the operative field. Herein, we present three cases that underwent open repair of the subclavian artery using the transmanubrial osteomuscular sparing approach, and we also highlight the utility of the technique along with the procedural details. Case presentation: Case 1: A 54-year-old man presented with a true aneurysm of the proximal portion of the right subclavian artery. The aneurysm measured 50 × 80 mm and compressed the right lung and trachea. We performed an aneurysm resection and a right subclavian artery reconstruction via the transmanubrial osteomuscular sparing approach under cardiopulmonary bypass support. Case 2: A 72-year-old man who presented with an abscess that formed around the left subclavian artery due to an unremoved guidewire during thoracic endovascular aortic repair for an aortic arch aneurysm in another hospital. After the antibiotics administration, debridement and axillary-axillary bypass were performed, and the guidewire was removed via a transmanubrial osteomuscular sparing approach with a use of cardiopulmonary bypass. Case 3: A 60-year-old man presented with misplacement of an indwelling dialysis catheter inserted for acute renal failure and hyperkalemia. The catheter was placed through the right neck, but had penetrated the right internal jugular vein and was misplaced from the right subclavian artery into the proximal aortic arch. Emergently, we removed the catheter using the transmanubrial osteomuscular sparing approach. Conclusions: The transmanubrial osteomuscular sparing approach to the subclavian artery provides an excellent view and a wide surgical field, even in different pathological situations. This is a simple, safe, and highly useful procedure and could be the standard approach for subclavian artery surgeries. [ABSTRACT FROM AUTHOR]

المؤلفون: Stiru, Ovidiu^1,2 (AUTHOR) ovidiu.stiru@umfcd.ro, Robu, Mircea^1,2 (AUTHOR) bubenek@alsys.ro, Platon, Pavel³ (AUTHOR) pavelplaton@yahoo.com, Bubenek-Turconi, Serban-Ion^1,4 (AUTHOR) vladanton.iliescu@gmail.com, Iliescu, Vlad Anton^1,2 (AUTHOR) catalina.parasca@gmail.com, Parasca, Catalina^1,2 (AUTHOR)

المصدر: Journal of Personalized Medicine. Jun2024, Vol. 14 Issue 6, p547. 10p.

مصطلحات موضوعية: *SUBCLAVIAN artery, *LITERATURE reviews, *ENDOVASCULAR aneurysm repair, *ENDOVASCULAR surgery, *THORACIC aorta, *DEGLUTITION disorders

مستخلص: Aberrant right subclavian artery (ARSA) causing dysphagia, the so-called "dysphagia lusoria", is a frequent embryologic anomaly of the aortic arch. In symptomatic patients, studies report several management options including surgical, hybrid, and totally endovascular strategies. Hybrid techniques have the advantage of no chest opening with reduced morbidity, but the problem of the ARSA stump causing recurrent or persistent dysphagia remains challenging in some cases. We conducted a literature review on the management strategies of ARSA and presented the case of a 72-year-old female patient with ARSA and dysphagia managed with thoracic endovascular repair of the aorta (TEVAR) and bilateral carotid–subclavian artery bypass. This technique was chosen because of the severe calcifications at the level of ARSA origin that would make surgical ligation difficult, or if an occluder device not suitable. We think that a patient-tailored approach should be considered in cases of dysphagia lusoria, considering that a multitude of strategies are reported. [ABSTRACT FROM AUTHOR]

المؤلفون: BOBADE, SHUBHAM¹ drbobade9@gmail.com, ASUTKAR, SHEETAL², KADAV, AMAR¹

المصدر: Journal of Clinical & Diagnostic Research. Jun2024, Vol. 18 Issue 6, p1-4. 4p.

مصطلحات موضوعية: *VARICOSE veins, *SUBCLAVIAN veins, *ARTERIOVENOUS fistula, *SODIUM sulfate, *CONGENITAL disorders, *TORTUOSITY

مستخلص: Varicose veins typically occur in the lower limbs, caused by valvular insufficiency leading to the swelling and tortuosity of subcutaneous veins. Although rare in the upper limbs, they can be successfully diagnosed and treated. Rare causes include congenital vascular anomalies like Klippel-Trenaunay syndrome and Parkes Weber syndrome, characterised by Arteriovenous (AV) fistulae. Subclavian vein thrombosis-induced venous outflow obstruction is another uncommon cause. Diagnosis involves a thorough history taking with clinical examination, often supplemented by investigations. Invasive procedures are rarely necessary but may be used in unique cases to define the pathology further. Treatment for upper limb varicose veins closely mirrors lower limb approaches. The stab-avulsion technique combined with stripping of lengthier sections yields outstanding cosmetic and functional results. Surgical ligation with stripping effectively eliminates varicosities with a low risk of recurrence. Sclerosing agents like Sodium Tetradecyl Sulphate and Polidocanol are substitutes for surgery. In cases of varicosities resulting from upper limb arteriovenous fistulae, surgical intervention involving ligation of the distal venous limb or division of the fistula is the standard approach. In summary, while upper limb varicose veins are exceptionally rare, they can be accurately diagnosed and effectively treated with surgical interventions similar to lower limb varicose veins. [ABSTRACT FROM AUTHOR]

المؤلفون: Asai, Masanari^1,2, Kiyokuni, Masayoshi¹ masakiyo1979@gmail.com, Hiroki, Uemura¹, Ishii, Kazuho¹, Tokoro, Takumi¹, Ishikawa, Hiroyuki², Kagimoto, Minako¹, Kataoka, Shunsuke¹, Kuji, Syotaro¹, Nakachi, Tatsuya¹, Endo, Tsutomu¹, Hibi, Kiyoshi³

المصدر: Pacing & Clinical Electrophysiology. Jun2024, Vol. 47 Issue 6, p815-819. 5p.

مصطلحات موضوعية: *AZYGOS vein, *SUBCLAVIAN veins, *CARDIAC pacing

مستخلص: Central venous obstruction following pacemaker implantation is not uncommon and can prove challenging in the case of a system upgrade to a cardiac resynchronization therapy pacemaker (CRT‐P). We describe the case of a patient who underwent a successful upgrading procedure of a pacemaker to a CRT‐P in the presence of an occluded left subclavian vein and superior vena cava, using collateral veins that drained into right atrium. [ABSTRACT FROM AUTHOR]

المؤلفون: Hu, Bin¹ (AUTHOR), Li, Jing¹ (AUTHOR) Lijing9803@163.com, Li, Liang¹ (AUTHOR), Yin, Hao¹ (AUTHOR), Zheng, Chong¹ (AUTHOR), Fan, Liu¹ (AUTHOR)

المصدر: World Neurosurgery. May2024, Vol. 185, pe1330-e1337. 8p.

مصطلحات موضوعية: *CEREBRAL angiography, *SUBCLAVIAN artery, *INTERNAL carotid artery, *PATIENTS' rights, *VERTEBRAL artery, *TRANSLUMINAL angioplasty

مستخلص: To assess the effectiveness and safety of neurological interventions using the right transradial approach (R-TRA) in patients with aberrant right subclavian artery (ARSA). We retrospectively analyzed cases that underwent cerebral angiography and interventions at Huangpi District People's Hospital from January 2023 to July 2023. Out of 335 cases, 5 patients with ARSA were identified. All 5 cases underwent diagnostic cerebral angiography via R-TRA. Two of the patients received interventions via R-TRA: 1 underwent right internal carotid artery balloon dilation angioplasty, while another underwent left vertebral artery stenting. No surgery-related complications were observed during these procedures. R-TRA proves to be a safe and effective option for neuro-interventional surgery in patients with ARSA. [ABSTRACT FROM AUTHOR]

المؤلفون: Kawano, Daisuke^1,2, Mori, Hitoshi¹ zin_ndmc@yahoo.co.jp, Taniwaki, Masanori², Tsutsui, Kenta¹, Kato, Ritsushi¹

المصدر: Pacing & Clinical Electrophysiology. May2024, Vol. 47 Issue 5, p664-667. 4p.

مصطلحات موضوعية: *PROSTHESIS-related infections, *SUBCLAVIAN veins, *COMPUTED tomography, *RARE diseases, *THORACIC outlet syndrome, *IMPLANTABLE cardioverter-defibrillators, *PHYSIOLOGIC strain, *CARDIAC pacemakers

مستخلص: The subclavian vein is typically used in cardiovascular implantable electronic device (CIED) implantations. External stress on the subclavian vein can lead to lead‐related complications. There are several causes of this stress, such as frequent upper extremity movements or external injury. Venous thoracic outlet syndrome (TOS) can also become the cause of external lead stress. However, the diagnosis of venous TOS can be challenging because subclavian venography can appear normal at first glance. We present a unique case of a device infection in a patient with venous TOS. A careful observation of the imaging studies is vital for diagnosing venous TOS and a leadless pacemaker implantation could be an alternative therapeutic option. [ABSTRACT FROM AUTHOR]

المؤلفون: Hatori, Kyohei¹ kyouhei_hatori@yahoo.co.jp, Mohara, Jun¹, Murata, Miyuki¹, Koyano, Tetsuya¹

المصدر: General Thoracic & Cardiovascular Surgery Cases. 5/2/2024, Vol. 3 Issue 1, p1-4. 4p.

مصطلحات موضوعية: *FALSE aneurysms, *SUBCLAVIAN artery, *AORTIC coarctation, *CONGENITAL heart disease, *LUNG injuries

مستخلص: Background: Coarctation of the aorta is a relatively common congenital heart defect. Various operative techniques have been proposed for aortic coarctation repair, which are tailored to individual patient circumstances. However, regardless of the chosen surgical approach, some patients may develop late thoracic pseudoaneurysms. Repeated surgery with a left thoracotomy increases the risk of lung injury and bleeding due to adhesions and rich collateral blood circulation. Case presentation: The patient underwent subclavian artery descending aortic bypass surgery for coarctation of the aorta at the age of 22 years and developed a pseudoaneurysm 30 years after bypass surgery. From the available surgical options for this condition, we selected total arch replacement using a frozen elephant trunk. The outcomes were excellent. Conclusions: Depending on each patient's circumstances, revision surgery using the frozen elephant trunk technique can be a viable option. [ABSTRACT FROM AUTHOR]