Fee H J, Gewirtz H S, O'Connell T X, Grollman J H
Ann Thorac Surg. 1978 Oct;26(4):387-90. doi: 10.1016/s0003-4975(10)62908-6.
Although cystic medial necrosis, either idiopathic or associated with Marfan's syndrome, usually becomes manifest as an ascending aortic aneurysm, aortic insufficiency, aortic dissection, or a combination of these disorders, a rare case of bilateral subclavian artery aneurysm secondary to idiopathic cystic medial necrosis has occurred. Subclavian artery aneurysms most commonly represent poststenotic dilatation from anterior scalene or cervical rib compression, occasionally are associated with generalized arteriosclerotic peripheral vascular disease, and rarely are secondary to syphilitic or mycotic infections. Subclavian artery aneurysms have a major risk of rupture, embolus, or thrombosis, and therefore should be repaired. A reverse saphenous vein or prosthetic bypass graft from the carotid to the axillary artery provides adequate flow to the upper extremity. The aneurysm should be completely excised if possible, since reexpansion through small collaterals or through insufficient closure by ligation can occur and compress the brachial plexus after successful bypass. The clinical presentation, angiographic findings, and operative repair of a subclavian artery aneurysm secondary to cystic medial necrosis are described.
尽管无论是特发性还是与马方综合征相关的囊性中层坏死，通常表现为升主动脉瘤、主动脉瓣关闭不全、主动脉夹层或这些病症的组合，但已出现1例罕见的继发于特发性囊性中层坏死的双侧锁骨下动脉瘤病例。锁骨下动脉瘤最常见的表现是前斜角肌或颈肋压迫导致的狭窄后扩张，偶尔与全身性动脉硬化性外周血管疾病相关，很少继发于梅毒或霉菌性感染。锁骨下动脉瘤有破裂、栓子形成或血栓形成的重大风险，因此应进行修复。从颈动脉到腋动脉的大隐静脉逆行或人工血管旁路移植可为上肢提供充足的血流。如果可能，应将动脉瘤完全切除，因为通过小侧支再扩张或结扎闭合不充分可能发生，并在成功旁路术后压迫臂丛神经。本文描述了继发于囊性中层坏死的锁骨下动脉瘤的临床表现、血管造影结果及手术修复情况。
