RESUMO
Coronary subclavian steal syndrome is an uncommon cause of angina in patients with a previous coronary artery bypass graft procedure. The patient had chest pain with the exertion of the left upper limb, difference in blood pressure between the left and right arm, occlusion at the ostium of the left subclavian artery. He underwent carotid subclavian bypass surgery that was successful in relieving symptoms. On the other hand, the patient had an embolic stroke related to the procedure and further assessment may be necessary.
Assuntos
Síndrome do Roubo Coronário-Subclávio , Síndrome do Roubo Subclávio , Masculino , Humanos , Síndrome do Roubo Coronário-Subclávio/diagnóstico por imagem , Síndrome do Roubo Coronário-Subclávio/cirurgia , Síndrome do Roubo Coronário-Subclávio/complicações , Síndrome do Roubo Subclávio/diagnóstico por imagem , Síndrome do Roubo Subclávio/cirurgia , Ponte de Artéria Coronária/efeitos adversos , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Angina Pectoris/etiologiaRESUMO
BACKGROUND: Clinical manifestations of thoracic outlet syndrome (TOS) differ depending on the compromised anatomic structure. Arterial TOS is the least common (1-5% of all cases of TOS), yet the most threatening, due to the risk of limb loss. METHODS: We conducted a retrospective review of consecutive patients treated for arterial TOS between January 1979 and June 2012. Medical records and diagnostic images were reviewed, and follow-up was obtained. RESULTS: Nineteen procedures were performed in 18 patients for symptomatic arterial TOS. The average age was 34 years (range 16-69 years), and 12 patients were female (63.2%). Surgical indications were upper limb critical ischemia in 8 (acute in 5 cases and acute-on-chronic in 3 cases) and claudication in 11. Imaging studies revealed a subclavian aneurysm in 7 patients, stenosis in 4 patients, and 2 patients with subclavian artery occlusion. The 6 remaining cases had symptoms caused by arterial compression in dynamic studies without arterial wall damage at rest. All limbs underwent surgery with outlet decompression; in addition, 13 underwent arterial reconstruction, and 7 were treated for distal embolic complications. There were no deaths, amputations, or early reoperations; 1 patient was readmitted 2 weeks after surgery for chylothorax, which resolved with conservative measures. During a mean follow-up of 155.8±103.1 months, 1 patient underwent successful reintervention at 4 months for bypass occlusion. CONCLUSIONS: Arterial TOS is an infrequent but relevant manifestation of TOS. An accurate and early diagnosis allows for timely surgery and adequate results, as shown in this group of patients.
Assuntos
Implante de Prótese Vascular , Descompressão Cirúrgica , Procedimentos de Cirurgia Plástica , Síndrome do Desfiladeiro Torácico/cirurgia , Extremidade Superior/irrigação sanguínea , Veias/transplante , Doença Aguda , Adolescente , Adulto , Idoso , Angiografia Digital , Anticoagulantes/uso terapêutico , Implante de Prótese Vascular/efeitos adversos , Chile , Doença Crônica , Quilotórax/etiologia , Quilotórax/terapia , Estado Terminal , Descompressão Cirúrgica/efeitos adversos , Embolectomia , Feminino , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/terapia , Humanos , Claudicação Intermitente/diagnóstico , Claudicação Intermitente/etiologia , Claudicação Intermitente/cirurgia , Isquemia/diagnóstico , Isquemia/etiologia , Isquemia/cirurgia , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Procedimentos de Cirurgia Plástica/efeitos adversos , Estudos Retrospectivos , Síndrome do Roubo Subclávio/complicações , Síndrome do Roubo Subclávio/diagnóstico , Síndrome do Roubo Subclávio/cirurgia , Síndrome do Desfiladeiro Torácico/diagnóstico , Síndrome do Desfiladeiro Torácico/etiologia , Terapia Trombolítica , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: To report a series of cases in which deliberate occlusion of the left Subclavian Artery (SA) caused the Subclavian Steal Syndrome (SSS). METHODS: Between January 2001 and August 2006, we performed 81 endovascular repairs of the Thoracic Aorta. 21 patients required left SA occlusion for an adequate proximal landing zone. 17 of these patients were treated by deliberate SA occlusion. Four patients (23.5%) developed a SSS, of which three were treated by a secondary Subclavian-to-carotid transposition, with complete remission of the SSS. RESULTS: The subclavian-to-carotid transposition was successful in the treatment of the 3 patients selected. One patient refused to be operated, and had only partial remission of the SSS symptoms. Mean follow-up was 28 months (range 2-48). CONCLUSION: In this series deliberate occlusion of the SA led to SSS in a significant number of patients. Consideration should be given to primary subclavian transposition in some patients requiring subclavian occlusion.
Assuntos
Aneurisma da Aorta Torácica/cirurgia , Complicações Intraoperatórias , Síndrome do Roubo Subclávio/etiologia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Idoso , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Angiografia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/cirurgia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Síndrome do Roubo Subclávio/diagnóstico , Síndrome do Roubo Subclávio/cirurgia , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
OBJECTIVE: Treatment of subclavian artery occlusion is still a matter of controversy due to the short- and long-term complications and patency issues. We report an unusual case of combined occlusion of the proximal segment of the left subclavian artery and subclavian steal phenomenon associated with bilateral occlusion of the internal carotid arteries. CASE DESCRIPTION: A 55-year-old male patient with previous history of myocardial infarction and hypertension presented with amblyopia and recurrent dizziness, mainly at work. Doppler fluxometry and digital subtraction angiography depicted proximal left subclavian artery occlusion and subclavian steal. Internal carotid arteries were occluded at the common carotid artery bifurcation. Percutaneous transluminal angioplasty and stenting (PTAS) were successfully performed by the left radial artery approach without complications. The patient had no recurrence of the symptoms, and the angiographic follow-up at 1 year showed good patency of the subclavian artery and normal flow through the left vertebral artery. CONCLUSION: The planned approach for the case (PTAS) was performed without complications and evidence of restenosis in the angiography study at the completion of the first year of the treatment. The described strategy is safe and should be considered the first-choice procedure in the treatment of the subclavian occlusion.
Assuntos
Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Stents , Síndrome do Roubo Subclávio/diagnóstico por imagem , Síndrome do Roubo Subclávio/cirurgia , Angioplastia com Balão/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Ultrassonografia Doppler em CoresRESUMO
Takayasu arteritis (TA) is a rare form of large-vessel, chronic, occlusive vasculitis. It involves mainly aorta and its main branches, causing stenosis and/or obstruction. Its frequency has been estimated at 2.9 cases per 1 million people. Epidemiologically, it is found principally in young female patients and is more prevalent in Asia and Latin America. When there is severe stenosis or occlusion in subclavian artery, the phenomenon of subclavian steal syndrome (SSS) occurs, which usually causes symptoms of the vertebrobasilar territory because blood supply to the arm is sustained by reversal of flow in ipsilateral vertebral artery. We describe a case of SSS thought to be due to TA in a Mexican woman. Doppler ultrasound of neck vessels showed retrograde flow in left vertebral artery during systole. Digital subtraction angiography confirmed 30% stenosis of left subclavian artery with filling of left vertebral artery in retrograde direction. In presenting this case, we carried out a brief review of TA, main features in imaging diagnosis of SSS, and the infrequently reported association of TA with SSS.