THORACIC OUTLET SYNDROME COMPLICATED BY DOUBLE SUBCLAVIAN ARTERY ANEURYSMS — AN HYBRID APPROACH

Detalhes bibliográficos
Autor(a) principal: Castro-Ferreira, Ricardo
Data de Publicação: 2017
Outros Autores: Gonçalves Dias, Paulo, Moreira Sampaio, Sérgio, Rolim, Dalila, Teixeira, José Fernando
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.
id RCAP_1c58e0805a62e7063be741b35a1e0bce
oai_identifier_str oai:ojs.acvjournal.com:article/32
network_acronym_str RCAP
network_name_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
repository_id_str 7160
spelling 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
instname_str Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron_str RCAAP
institution RCAAP
reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
collection Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
repository.mail.fl_str_mv
_version_ 1799129847937630208