Myers J L, Gomes M N
Department of Surgery, Georgetown University Medical Center, Washington, DC 20007, USA.
J Cardiovasc Surg (Torino). 2000 Aug;41(4):607-12.
An aberrant subclavian artery is the most common congenital anomaly of the aortic arch. Aneurysms of these vessels are relatively rare lesions. A high clinical suspicion must be maintained in patients with an abnormal mediastinum on chest X-ray, especially in patients with dysphagia, dyspnea, or upper extremity ischemic symptoms not otherwise explained. Potentially disastrous complications, including spontaneous rupture and perforation into the esophagus may occur, and are invariably fatal. We present the case of an 1 asymptomatic 72-year-old male with an aberrant right c subclavian artery aneurysm presenting as a mediastinal mass on routine chest X-ray. Repair was by aneurysmectomy through a left thoracotomy and right common carotid artery to subclavian artery bypass via median sternotomy with resolution of his symptoms. We reviewed 74 cases in the English literature to February 1998. The pertinent anatomy is discussed and trends in surgical treatment are identified. Recent agreement on the surgical approach and choice of revascularization appears to exist, but advances in diagnostic and interventional radiologic capabilities have increased the number of asymptomatic lesions encountered and may alter the treatment of this lesion in the near future.
迷走锁骨下动脉是主动脉弓最常见的先天性异常。这些血管的动脉瘤是相对罕见的病变。对于胸部X线显示纵隔异常的患者，尤其是伴有吞咽困难、呼吸困难或无其他明确原因的上肢缺血症状的患者，必须保持高度的临床怀疑。可能会发生包括自发破裂和穿孔至食管等潜在灾难性并发症，且这些并发症往往是致命的。我们报告一例72岁无症状男性病例，其右迷走锁骨下动脉瘤在常规胸部X线检查时表现为纵隔肿块。通过左胸切口行动脉瘤切除术，并经正中胸骨切开术行右颈总动脉至锁骨下动脉旁路移植术，症状得以缓解。我们回顾了截至1998年2月英文文献中的74例病例。讨论了相关解剖结构并确定了手术治疗的趋势。目前似乎在手术入路和血运重建选择方面已达成共识，但诊断和介入放射学能力的进步增加了无症状病变的发现数量，可能在不久的将来改变对此类病变的治疗方式。
