Nishimori H, Hirose K, Fukutomi T, Oda K, Sato K, Yamashiro T
Department of Surgery II, Kochi Medical School, Japan.
Jpn J Thorac Cardiovasc Surg. 1999 Dec;47(12):621-4. doi: 10.1007/BF03218075.
We performed surgery on a 61-year-old woman who had increasingly severe right shoulder pain and paresthesia in her right upper extremity as a result of a large right subclavian artery aneurysm. She had suffered from aortitis syndrome for 10 years for which she was treated with steroids and had multiple arterial lesions, including bilateral subclavian artery aneurysms, abdominal aortic aneurysm and obstruction of bilateral superficial femoral arteries. The right subclavian artery aneurysm measured 4 cm in diameter and rupture appeared imminent, prompting surgical therapy. Via the supraclavicular incision approach and additional partial sternotomy, the aneurysm was excluded and the brachiocephalic to right axillar arterial bypass was set up using an extended polytetrafluoroethylene graft. The patient recovered without complications and a subclavian artery aneurysm demonstrated by computed tomography was thrombosed 1 month after surgery. In conclusion, we recommend the exclusion technique to treat subclavian artery aneurysms in cases in which aneurysmectomy is likely to injure adjacent veins and nerves.
我们对一名61岁女性进行了手术,该患者因右锁骨下动脉巨大动脉瘤,出现右肩部疼痛日益加重及右上肢感觉异常。她患高安动脉炎综合征10年,一直接受类固醇治疗,存在多处动脉病变,包括双侧锁骨下动脉瘤、腹主动脉瘤以及双侧股浅动脉阻塞。右锁骨下动脉瘤直径达4厘米,似乎即将破裂,因此进行手术治疗。通过锁骨上切口入路并附加部分胸骨切开术,将动脉瘤排除,并使用延长的聚四氟乙烯移植物建立头臂干至右腋动脉旁路。患者康复,无并发症,术后1个月计算机断层扫描显示锁骨下动脉瘤已形成血栓。总之,对于动脉瘤切除术可能会损伤相邻静脉和神经的锁骨下动脉瘤病例,我们推荐采用排除技术进行治疗。