rare presenta*on and management of a complex subclavian artery aneurysm … · 2016-01-25 · rare...
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Rare presenta*on and management of a complex subclavian artery aneurysm
Speaker:DrSandeepMohananInterven2onists:DrVinayakumarD,ProfMNKrishnan,DrCicyBas2an
DepartmentofCardiology,CalicutMedicalCollege
The pa'ent... • 32yearoldfemale,motheroftwo• Dysphagiatosolids-2m• No8cedswellingwithdiscomfortintheneck• Nosignificantpastmedicalhistory
• Clinicalexamina2on:- Pulsa8leswellingintherootofrightsideoftheneck- Bruit+- Allperipheralpulsespalpable- Allsystems–wnl- Nofever
Chest Xray
MDCT angiogram
MDCT-angio reconstruc'on
Complexmul2loculatedsaccularaneurysminRightSCA
Ae'ological work up • CBC-Normal• ESR,CRP-Normal• ANA,RF:-ve• HIV,HBsAg,HCV:-ve• VDRL:-ve• C-ANCA,p-ANCA:-ve• TFT:-ve
• OGDscopy:Normal• Echocardiography:Normalstudy• Coronaryangiogram:Normal• CECTchest(16sliceCT):Noaddi8onalvascularabnormali8es
Barium swallow
APview RAOview
Selec've right innominate DSA
Management
Diagnosis:Idiopathicrightsubclavianarterycomplexaneurysmwithcompressivesymptoms.
Op8ons:Surgicalcorrec8onvsEndovascularstent-graK-AVerfewweeksshepresentedwithpain,visibleenlargementinrootofneck.
!AdmiLedandurgentlyarrangedBardFluencyvascularstent-gra2s
Right radial and right femoral access
ADemp'ng to pass Terumo wire across the aneurysm
Terumo wire successfully crossed with JR support from above and snared from below
ADemp'ng to track catheter across the aneurysm
Exchanged with Amplatzer wire and 10F ASD sheath inserted
Deployment of 1st stent (10 *80mm 9F Fluency stent graQ)
Undeployed proximal stent - ? Tight stenosis
Stent displaced into the aneurysm
Deployment of 2nd stent (12 * 40mm 10F Fluency plus)
Dumbell shaped stent- stenosis at aneurysm mouth
Final injec'on
Post procedure imaging
1 year Follow up
• Noswallowingdifficulty• Asymptoma8c,
• Nobruit/swelling• Allpulsespalpable
Literature Review • Epidemiology:0.13%ofallaneurysms.• Ae2ology: Atherosclerosis(60%), trauma, infec8ons(TB, syphilis,bacterial), vasculi8s, CTDs, thoracic outlet obstruc8on, Marfanssyndrome,collagenvasculardiseases,aberrantSCA,congenital.
• Common Presenta2ons: Pulsa8le lump, brachial plexuscompression, upper limb ischema, incidentalmedias8nalwidening,hemoptysis(erosionoflungapex),hoarsenessofvoice
• Rarepresenta2ons:Dyspnoea,dysphagia,Hornerssyndrome
1. Dentetal.Atheroscelro9carterialaneurysms:ArchSurg1972.2. Doughertyetal.Atherosclero9caneurysmiftheintrathoracicsubclavianartery:acasereportand
reviewofliterature.JVascSurg1995
Inves'ga'ons
• Vasculi8s:PAN,Takayasuarteri8s• CTDs-SLA,RA,Ankylosingspondyli8s• Infec8on:TB,HIV,HCV,HBsAg,Syphilis• ACVD• USG-Doppler• CTAisinves2ga2onofchoiceforanatomydelinea2on
Treatment
• Surgical:Liga8on,Arteriorrhapphy,graVing
• Endovascularstent-graVing(mul8plecasereports)
THANK YOU
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