Cervical aortic arch with aneurysm formation and an anomalous right subclavian artery and left vertebral artery:A case report

BACKGROUND A cervical aortic arch(CAA)refers to a high-riding aortic arch(AA)that often extends above the level of the clavicle.This condition is very rare,with an incidence of less than 1/10000.CASE SUMMARY A 29-year-old woman was admitted to the otolaryngology department of our hospital for repeated bilateral purulent nasal discharge for the prior 3 mo.The patient was diagnosed with chronic sinusitis and chronic rhinitis at admission.A preoperative noncontrast chest computed tomography scan showed a high-riding,tortuous AA extending to the mid-upper level of the first thoracic vertebra with local cystic dilatation.A further computed tomography angiography examination showed that the brachiocephalic trunk,left common carotid artery,left vertebral artery(LVA)(slender),and left subclavian artery sequentially branched off of the aorta from the proximal end to the distal end of the AA.The proximal end of the right subclavian artery(RSCA)was tortuous and dilated.The AA showed tumorlike local expansion,with a maximum diameter of approximately 4 cm.After consultation with the department of cardiac macrovascular surgery,the patient was diagnosed with left CAA with aneurysm formation and an anomalous RSCA and LVA and was transferred to that department.The patient underwent AA aneurysm resection and artificial blood vessel replacement under general anesthesia and cardiopulmonary bypass.No abnormality was found during the 2-mo follow-up after discharge.CONCLUSION A CAA is a rare congenital anomaly of vascular development.The present unique case of CAA with aneurysm formation and an anomalous RSCA and LVA enriches existing CAA data.

颈位主动脉弓伴动脉瘤的MRI及MRA表现

目的 :分析颈位主动脉弓伴动脉瘤的MRI及MRA表现 ,初步探讨两种方法对其诊断价值。方法 :3例颈位主动脉弓伴动脉瘤均作MRI检查 ,其中 1例作时间飞跃法磁共振血管成像 (2 dimensionaltime of flightMRA ,2DTOFMRA)检查 ,1例作 3DDCEMRA检查 ,另 1例同时作 2DTOFMRA及 3DDCEMRA检查。结果 :MRI与MRA均能明确诊断颈位主动脉弓 ,对弓上分支血管的显示 ,MRA优于MRI,3DDCEMRA优于 2DTOFMRA ,对动脉瘤的显示 ,MRI与 3DDCEMRA优于2DTOFMRA。结论 :对于颈位主动脉弓伴动脉瘤的显示 ,应选用

左颈位主动脉弓动脉瘤的外科治疗

目的：总结颈位主动脉弓（cervical aortic arch，CAA）动脉瘤的外科治疗方法及术后早中期效果。方法2010年1月至2014年12月，收治22例CAA动脉瘤患者，均为左位CAA。其中男6例，女16例，年龄（34.09±13.14）岁。术前合并主动脉假性狭窄9例，高血压3例，主动脉瓣反流、Stanford B型主动脉夹层、大脑中动脉瘤各1例。所有患者均采用人工血管替换术行主动脉弓重建。4例（4／22，18.18％）经胸骨正中切口，中度低温停循环、选择性顺行脑灌注下手术，其中同期行主动脉瓣置换术1例；18例（18／22，81.82％）经左后外侧第4肋间切口手术，其中10例体外循环辅助下实施手术，8例直接阻断下手术。结果全组平均呼吸机辅助（13.05±4.73） h，ICU停留（19.14±8.08） h。术后二次开胸止血1例，切口延迟愈合1例，一过性肝功能不全1例。无院内死亡。术后19例随访平均34.73个月，失访3例。随访期间无死亡。结论 CAA动脉瘤患者应积极手术治疗。根据CAA动脉瘤的位置、类型以及合并的其他近端心血管疾病，选择个体化的手术切口、辅助技术及手术方法，一期行主动脉弓重建手术治疗CAA动脉瘤可获得满意的临床效果。