Esophageal Neoplasms ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Radiography ; Subclavian Artery ; abnormalities ; diagnostic imaging ; surgery

Aneurysm, Dissecting ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Radiography ; Subclavian Artery ; diagnostic imaging ; surgery

Adolescent ; Catheterization, Central Venous ; adverse effects ; Humans ; Jugular Veins ; Male ; Mammary Arteries ; injuries ; Subclavian Artery ; surgery

Subclavian artery thrombosis is a rare complication of clavicle fractures. We reported a 20-year-old man who was admitted to the emergency room after a road traffic accident. He was a pedestrian who was initially hit by a bus and after he fell down on the road, he was run over by a car. On evaluation, he was found to have multiple facial and rib fractures, distal right humerus and right clavicle fracture. Significantly, right radial pulse was absent. After further evaluation including Doppler studies and an angiography which revealed complete obstruction of right subclavian artery just distal to its 1st portion, the patient was urgently taken to the operation room. A midclavicular fracture was adjacent to the injured vessel. We established proximal and distal control, removed damaged part. After mobilizing the subclavian artery, an end-to-end anastomosis was made. Then open reduction and internal fixation of right distal humerus was performed. The rest of the postoperative course was unremarkable. To prevent complications of subclavian artery thrombosis, different treatment modalities can be used, including anticoagulation therapy, angioplasty, stenting and bypass procedures.
Anastomosis, Surgical ; Clavicle ; injuries ; Fractures, Bone ; complications ; Humans ; Male ; Subclavian Artery ; injuries ; surgery ; Thrombosis ; etiology ; surgery ; Young Adult

Adolescent ; Adult ; Child ; Female ; Hemostasis, Surgical ; methods ; Humans ; Male ; Middle Aged ; Subclavian Artery ; injuries ; Subclavian Vein ; injuries ; Vascular Surgical Procedures ; methods ; Wounds and Injuries ; surgery

The assessment of the accuracy of Electron Beam Computed Tomography (EBCT) for the follow-up of pulmonary vascular system after the shunt operation in cyanotic congenital heart diseases was purpose of the study. The study group consists of 16 consecutive patients with cyanotic congenital heart disease who had Blalock-Taussig (BT) shunt (n=7), bi- directional cavo-pulmonary shunt (BCPS, n=7) and unifocalization (n=2). EBT images were obtained on systolic phase under EKG gating and after intravenous administration of contrast agent. We evaluated the shunt patency, anatomy of intrapericardial pulmonary artery, parenchymal pulmonary vessels and background lung attenuation for the pulmonary blood flow, and the presence of systemic arterial and venous collaterals. Angiography (n=12) and echocardiography (n=16) were used as the gold standards. EBCT was consistent with angiogram in detecting the shunt patency and in depicting the anatomy of the intrapericardial pulmonary artery. Occlusion of the BT shunts was not detected in 2 patients by echocardiography. Diffuse or focally decreased pulmonary flow on EBCT in 8 patients was consistent with the pulmonary hemodynamics pattern revealed by cardiac catheterization. Uneven attenuation between lobes was related with multifocal supply of pulmonary flow or occlusion of lobar pulmonary arteries. Systemic collateral arteries were observed in 5 at the corresponding site of the decreased pulmonary flow. Systemic venous collaterals seen in all patients following BCPS were eventually draining to the inferior vena cava in 5 and to the left atrium in 2. EBCT provided accurate information of the pulmonary vascular system after shunt and has unique advantage over echocardiography in assessing patency of BT shunt or unifocalization tubes within the pleural space, the estimation of regional difference in pulmonary hemodynamics, and the detection of systemic collateral vessels. Therefore EBCT may provide useful information about the timing of definitive correction and the need for a second shunt or an interventional procedure prior to total repair.
Child ; Child, Preschool ; Collateral Circulation ; Female ; Heart Defects, Congenital/physiopathology/*radiography/*surgery ; Human ; Infant ; Male ; Pulmonary Artery/*surgery ; Pulmonary Circulation ; Subclavian Artery/*surgery ; *Tomography, X-Ray Computed

A 59-year-old woman was scheduled for mitral valvuloplasty and Maze operation. As operation was planed to use the robotically controlled camera (Aesop 3000, Computermotion(r), USA) for the minimally invasive robot-assisted thoracotomy, a superior vena cava (SVC) cannula (Femoral arterial cannula [21 Fr], Medtronic(r), USA) was inserted in the right internal jugular vein. After insertion of the SVC cannula, a pulmonary artery (PA) catheter (Swan-Ganz CCOmbo V [7.5 Fr], Edwards(r), USA) was inserted through an advanced venous access device (AVA 3Xi [8.5 Fr], Edwards(r), USA) in the right subclavian vein. The tip of the PA catheter could not be advanced into SVC and blood was not regurgitated. In the chest AP X-ray, it was found that the advanced venous access device was kinked by the SVC cannula. So the advanced venous access device was withdrawn about 5 cm and the PA catheter was advanced easily to the destination.
Catheters* ; Female ; Humans ; Jugular Veins ; Middle Aged ; Pulmonary Artery* ; Subclavian Vein ; Thoracic Surgery* ; Thoracotomy ; Thorax ; Vena Cava, Superior*

This study reports our early experience with thoracoscopic division of vascular rings. Three patients were reviewed; their ages at surgery were 25 months, 4 years, and 57 years. All patients were suffering from complete vascular rings involving combinations of the right aortic arch, left ligamentum arteriosum, Kommerell's diverticulum, and retroesophageal left subclavian artery. The median surgical time was 180.5 minutes, and the patients showed immediate recovery. Three complications, namely chylothorax, transient supraventricular tachycardia, and left vocal cord palsy, were observed. Our early experience indicates that thoracoscopic division of a vascular ring may provide early recovery and could be a promising operative choice.
Aorta, Thoracic ; Chylothorax ; Diverticulum ; Humans ; Operative Time ; Subclavian Artery ; Tachycardia, Supraventricular ; Thoracic Surgery, Video-Assisted ; Vocal Cord Paralysis

Catheterization ; adverse effects ; methods ; Catheterization, Central Venous ; adverse effects ; methods ; Female ; Humans ; Middle Aged ; Subclavian Artery ; surgery

BACKGROUNDMost of endovascular stent-graft modifications to preserve side branch must be customized according to extensive pre-operative assessment, which may not be possible in many hospitals and emergency settings. The study was to develop a novel stent-grafts system that would allow in situ "fenestration", with less reliance on preoperative imaging.

METHODSThe magnitude of pressure difference (PD) between left subclavian artery (LSA) and aortic arch were measured in 12 experimental pigs. Changes of PD before and after LSA was covered were analyzed respectively. The novel stent graft was made by multi-dimensional and multiple textiles forming technology. According to the PD measurement in pigs, we evaluated the feasibility of the stent-graft in a mock circulation system.

RESULTSIn pigs, the blood pressure of aortic arch was significantly higher than that of LSA after it was covered (P < 0.001) and PD was (42.78 ± 5.17) mmHg. After target vessel was covered and when PD between the LSA and aorta reached the magnitude measured in pigs, contrast media oozed from the cranny of graft to the LSA, which was generated by sliding and deformation of yarns of novel stent-graft.

CONCLUSIONSThe study proposes the design of pressure difference-induced perforation aortic stent-grafts system and verifies that the PD between LSA and aortic arch is high enough to allow in situ "fenestration" by stent graft made by multi-dimensional and multiple textiles forming technology.

Animals ; Aorta, Thoracic ; surgery ; Blood Pressure ; physiology ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation ; Prosthesis Design ; Subclavian Artery ; Swine