THORACIC OUTLET SYNDROME COMPLICATED BY DOUBLE SUBCLAVIAN ARTERY ANEURYSMS — AN HYBRID APPROACH
Autor(a) principal: | |
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Data de Publicação: | 2017 |
Outros Autores: | , , , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.48750/acv.32 |
Resumo: | Introduction: Subclavian artery aneurysm (SAA) can be an extremely rare complication of thoracic outlet syndrome (TOS). The arterial dilation usually occurs distal to the stenosis site causing TOS. We describe a rare case of a patient with neurological TOS with two voluminous SAA proximal and distal to interscalene triangle. Case report: A 55 years-old female patient, with no prior medical conditions, was referred to vascular surgery clinic with symptoms of neurological TOS. The radial pulses were absent in the affected limb but the patient had no arterial complains. In the work-up angio-CT two consecutive SAA (31 and 42mm) divided by anterior scalenus muscle were diagnosed. The aneurysms were excluded by covered stent angioplasty after circle of Willis flow assessment by transcranial Doppler. Subsequently the patient was submitted to anterior scalenectomy in operating theatre. The symptoms completely reversed and the patient was discharged two days after surgery. Follow-up angio-CT confirmed SAA exclusion. Patient remains asymptomatic 6 months after the treatment. Discussion: The term thoracic outlet syndrome was originally used in 1956 by RM Peet to designate compression of the neurovascular bundle at the thoracic outlet3. Since its original description, a multitude of clinical entities was associated with TOS. SAA is a rare but potential dangerous complication of TOS. Whereas historically SAA have been managed by open surgery, the novel endovascular methods offer an elegant and safer approach to this condition. Although first rib resection is emerging as the regular method of thoracic outlet decompression, this particular case imaging was highly suggestive of scalenus muscle compression. This case exemplifies how endovascular and open approaches can elegantly work together with remarkable results. To the best of our knowledge, this is the first description of a double subclavian artery aneurysm in the context of TOS. |
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THORACIC OUTLET SYNDROME COMPLICATED BY DOUBLE SUBCLAVIAN ARTERY ANEURYSMS — AN HYBRID APPROACHSÍNDROME DO DESFILADEIRO TORÁCICO COMPLICADA POR DUPLO ANEURISMA SUBCLÁVIO — UMA ABORDAGEM HÍBRIDAThoracic Outlet SyndromeSubclavian Artery AneurysmHybrid ApproachSíndrome do Desfiladeiro TorácicoAneurisma da Artéria SubcláviaAbordagem HíbridaIntroduction: Subclavian artery aneurysm (SAA) can be an extremely rare complication of thoracic outlet syndrome (TOS). The arterial dilation usually occurs distal to the stenosis site causing TOS. We describe a rare case of a patient with neurological TOS with two voluminous SAA proximal and distal to interscalene triangle. Case report: A 55 years-old female patient, with no prior medical conditions, was referred to vascular surgery clinic with symptoms of neurological TOS. The radial pulses were absent in the affected limb but the patient had no arterial complains. In the work-up angio-CT two consecutive SAA (31 and 42mm) divided by anterior scalenus muscle were diagnosed. The aneurysms were excluded by covered stent angioplasty after circle of Willis flow assessment by transcranial Doppler. Subsequently the patient was submitted to anterior scalenectomy in operating theatre. The symptoms completely reversed and the patient was discharged two days after surgery. Follow-up angio-CT confirmed SAA exclusion. Patient remains asymptomatic 6 months after the treatment. Discussion: The term thoracic outlet syndrome was originally used in 1956 by RM Peet to designate compression of the neurovascular bundle at the thoracic outlet3. Since its original description, a multitude of clinical entities was associated with TOS. SAA is a rare but potential dangerous complication of TOS. Whereas historically SAA have been managed by open surgery, the novel endovascular methods offer an elegant and safer approach to this condition. Although first rib resection is emerging as the regular method of thoracic outlet decompression, this particular case imaging was highly suggestive of scalenus muscle compression. This case exemplifies how endovascular and open approaches can elegantly work together with remarkable results. To the best of our knowledge, this is the first description of a double subclavian artery aneurysm in the context of TOS.Introdução: Aneurismas da artéria subclávia (AAS) são uma complicação extremamente rara da síndrome do desfiladeiro torácico (SDT). A dilatação arterial ocorre normalmente distalmente ao local de compressão que está na base do SDT. Descrevemos um caso particularmente raro de um doente com SDT neurológico com dois volumosos AAS proximal e distal ao triângulo interescaleno. Caso Clínico: Mulher, 55 anos, sem antecedentes de relevo. Actividade profissional desde a adolescência implica transporte manual de caixas pesadas diversas vezes ao dia. Foi referenciada à consulta de cirurgia vascular por sintomas neurológicos compatíveis com SDT. Angio-TC revelou a presença de dois volumosos AAS, de 31 e 42mm, separados pelo musculo escaleno anterior. Os aneurismas foram excluídos com stent recoberto (Viabahn) após ter sido comprovada patência do polígono de Willis por Doppler transcraniano. Subsequentemente a doente foi submetida a escalenotomia anterior. Constatou-se reversão total dos sintomas, tendo a doente tido alta 2 dias após a cirurgia. Angio-TC de controlo comprovou exclusão dos 2 AAS. Doente mantém-se assintomática aos 6 meses de follow-up. Discussão: O termo SDT foi originalmente utilizado em 1956 por RM Peet para descrever a compressão do feixe neurovascular ao nível do outlet torácico. O desenvolvimento de AAS é uma complicação rara, mas potencialmente perigosa da SDT. Embora historicamente tenha sido abordado por cirurgia aberta, os novos métodos endovasculares afirmam-se como uma opção elegante e de menor risco no tratamento de AAS. Embora a exérese da primeira costela se esteja a assumir como o tratamento a oferecer para a descompressão do desfiladeiro torácico, neste caso particular, a imagem e a história clínica foram altamente sugestivas de compressão pelo músculo escaleno. Este caso demonstra como as abordagens endovascular e aberta se podem conjugar para oferecer resultados aliciantes. Do nosso conhecimento, esta é a primeira descrição na literatura de dois aneurismas em série da artéria subclávia no contexto de SDT.Sociedade Portuguesa de Angiologia e Cirurgia Vascular2017-12-30T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.48750/acv.32oai:ojs.acvjournal.com:article/32Angiologia e Cirurgia Vascular; Vol. 13 No. 4 (2017): December; 34-36Angiologia e Cirurgia Vascular; Vol. 13 N.º 4 (2017): Dezembro; 34-362183-00961646-706Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporhttp://acvjournal.com/index.php/acv/article/view/32https://doi.org/10.48750/acv.32http://acvjournal.com/index.php/acv/article/view/32/65Copyright (c) 2017 Angiologia e Cirurgia Vascularinfo:eu-repo/semantics/openAccessCastro-Ferreira, RicardoGonçalves Dias, PauloMoreira Sampaio, SérgioRolim, DalilaTeixeira, José Fernando2022-05-23T15:09:58Zoai:ojs.acvjournal.com:article/32Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T14:57:27.054457Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
THORACIC OUTLET SYNDROME COMPLICATED BY DOUBLE SUBCLAVIAN ARTERY ANEURYSMS — AN HYBRID APPROACH SÍNDROME DO DESFILADEIRO TORÁCICO COMPLICADA POR DUPLO ANEURISMA SUBCLÁVIO — UMA ABORDAGEM HÍBRIDA |
title |
THORACIC OUTLET SYNDROME COMPLICATED BY DOUBLE SUBCLAVIAN ARTERY ANEURYSMS — AN HYBRID APPROACH |
spellingShingle |
THORACIC OUTLET SYNDROME COMPLICATED BY DOUBLE SUBCLAVIAN ARTERY ANEURYSMS — AN HYBRID APPROACH Castro-Ferreira, Ricardo Thoracic Outlet Syndrome Subclavian Artery Aneurysm Hybrid Approach Síndrome do Desfiladeiro Torácico Aneurisma da Artéria Subclávia Abordagem Híbrida |
title_short |
THORACIC OUTLET SYNDROME COMPLICATED BY DOUBLE SUBCLAVIAN ARTERY ANEURYSMS — AN HYBRID APPROACH |
title_full |
THORACIC OUTLET SYNDROME COMPLICATED BY DOUBLE SUBCLAVIAN ARTERY ANEURYSMS — AN HYBRID APPROACH |
title_fullStr |
THORACIC OUTLET SYNDROME COMPLICATED BY DOUBLE SUBCLAVIAN ARTERY ANEURYSMS — AN HYBRID APPROACH |
title_full_unstemmed |
THORACIC OUTLET SYNDROME COMPLICATED BY DOUBLE SUBCLAVIAN ARTERY ANEURYSMS — AN HYBRID APPROACH |
title_sort |
THORACIC OUTLET SYNDROME COMPLICATED BY DOUBLE SUBCLAVIAN ARTERY ANEURYSMS — AN HYBRID APPROACH |
author |
Castro-Ferreira, Ricardo |
author_facet |
Castro-Ferreira, Ricardo Gonçalves Dias, Paulo Moreira Sampaio, Sérgio Rolim, Dalila Teixeira, José Fernando |
author_role |
author |
author2 |
Gonçalves Dias, Paulo Moreira Sampaio, Sérgio Rolim, Dalila Teixeira, José Fernando |
author2_role |
author author author author |
dc.contributor.author.fl_str_mv |
Castro-Ferreira, Ricardo Gonçalves Dias, Paulo Moreira Sampaio, Sérgio Rolim, Dalila Teixeira, José Fernando |
dc.subject.por.fl_str_mv |
Thoracic Outlet Syndrome Subclavian Artery Aneurysm Hybrid Approach Síndrome do Desfiladeiro Torácico Aneurisma da Artéria Subclávia Abordagem Híbrida |
topic |
Thoracic Outlet Syndrome Subclavian Artery Aneurysm Hybrid Approach Síndrome do Desfiladeiro Torácico Aneurisma da Artéria Subclávia Abordagem Híbrida |
description |
Introduction: Subclavian artery aneurysm (SAA) can be an extremely rare complication of thoracic outlet syndrome (TOS). The arterial dilation usually occurs distal to the stenosis site causing TOS. We describe a rare case of a patient with neurological TOS with two voluminous SAA proximal and distal to interscalene triangle. Case report: A 55 years-old female patient, with no prior medical conditions, was referred to vascular surgery clinic with symptoms of neurological TOS. The radial pulses were absent in the affected limb but the patient had no arterial complains. In the work-up angio-CT two consecutive SAA (31 and 42mm) divided by anterior scalenus muscle were diagnosed. The aneurysms were excluded by covered stent angioplasty after circle of Willis flow assessment by transcranial Doppler. Subsequently the patient was submitted to anterior scalenectomy in operating theatre. The symptoms completely reversed and the patient was discharged two days after surgery. Follow-up angio-CT confirmed SAA exclusion. Patient remains asymptomatic 6 months after the treatment. Discussion: The term thoracic outlet syndrome was originally used in 1956 by RM Peet to designate compression of the neurovascular bundle at the thoracic outlet3. Since its original description, a multitude of clinical entities was associated with TOS. SAA is a rare but potential dangerous complication of TOS. Whereas historically SAA have been managed by open surgery, the novel endovascular methods offer an elegant and safer approach to this condition. Although first rib resection is emerging as the regular method of thoracic outlet decompression, this particular case imaging was highly suggestive of scalenus muscle compression. This case exemplifies how endovascular and open approaches can elegantly work together with remarkable results. To the best of our knowledge, this is the first description of a double subclavian artery aneurysm in the context of TOS. |
publishDate |
2017 |
dc.date.none.fl_str_mv |
2017-12-30T00:00:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.48750/acv.32 oai:ojs.acvjournal.com:article/32 |
url |
https://doi.org/10.48750/acv.32 |
identifier_str_mv |
oai:ojs.acvjournal.com:article/32 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.none.fl_str_mv |
http://acvjournal.com/index.php/acv/article/view/32 https://doi.org/10.48750/acv.32 http://acvjournal.com/index.php/acv/article/view/32/65 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2017 Angiologia e Cirurgia Vascular info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2017 Angiologia e Cirurgia Vascular |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
publisher.none.fl_str_mv |
Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
dc.source.none.fl_str_mv |
Angiologia e Cirurgia Vascular; Vol. 13 No. 4 (2017): December; 34-36 Angiologia e Cirurgia Vascular; Vol. 13 N.º 4 (2017): Dezembro; 34-36 2183-0096 1646-706X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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