Subclavian artery aneurysm is a rare phenomenon in the West, but its prevalence is increasingly proportionate to incidence of atherosclerotic disease in the population. It is generally accepted that gold standard care...Subclavian artery aneurysm is a rare phenomenon in the West, but its prevalence is increasingly proportionate to incidence of atherosclerotic disease in the population. It is generally accepted that gold standard care is surgical resection but with limited experience opportunity remains to optimise this. We report on a 66-year-old female arteriopath with an 8 cm intra-thoracic aneurysm of the right subclavian artery, just distal to the brachiocephalic trunk. Lack of a proximal landing zone prohibited endovascular repair thus we utilised the anterior transcervical approach described by Dartevelle. This approach provided excellent visualisation of the aneurysm, along with right vagus and phrenic nerves, facilitating proximal and distal control and subsequent decompression. Post operative recovery was swift and not marred by substantial pain or inhibition of chest wall mechanics, associated with median sternotomy and thoracotomy incisions usually advocated for such aneurysms. As such we purport this approach to offer excellent operative exposure for this increasing disease burden, with less morbidity associated than the currently accepted approach, representing an advance in the management of this condition.展开更多
Penetrating injuries to the subclavian arteries as well as post traumatic pseudoaneurysm involving Subclavian artery (SCA) are very much uncommon. We present one case of a 21 year-old male sustained a physical assault...Penetrating injuries to the subclavian arteries as well as post traumatic pseudoaneurysm involving Subclavian artery (SCA) are very much uncommon. We present one case of a 21 year-old male sustained a physical assault with a <span>post stab injury left subclavian artery pseudoaneurysm. He was referred to ou</span>r facility, two days after sustaining a penetrating chest trauma over left i<span><span><span style="font-family:;" "="">n</span></span></span><span><span><span style="font-family:;" "="">frac<span>lavicular area of the chest. The presentation, diagnostic procedures and surg</span>ical approach for management of this very rare injury are discussed.</span></span></span>展开更多
BACKGROUND Although the number of patients who need central venous ports for permanent vascular access is increasing,there is still no“gold standard”for the implantation technique.AIM To identify the implantation te...BACKGROUND Although the number of patients who need central venous ports for permanent vascular access is increasing,there is still no“gold standard”for the implantation technique.AIM To identify the implantation technique that should be favored.METHODS Two hundred central venous port-implanted patients in a tertiary hospital were retrospectively evaluated.Patients were assigned into two groups according to the access method.The first group comprised patients whose jugular veins were used,and the second group comprised patients whose subclavian veins were used.Groups were evaluated regarding age,sex,application side,primary diagnosis,active follow-up period in the hospital,chemotherapy agents administered,number of complications,and the Clavien-Dindo severity score.The distribution of the variables was tested with the Kolmogorov-Smirnov test and the Mann-Whitney U test.Theχ^(2) test was used to analyze the variables.RESULTS There was no statistically significant difference between the groups regarding age,sex,side,number of chemotherapy drugs,and duration of port usage(P>0.05).Only 2 patients in group 1 had complications,whereas in group 2 we observed 19 patients with complications(P<0.05).No port occlusion was found in group 1,but the catheters of 4 patients were occluded in group 2.One port was infected in group 1 compared to three infected ports in group 2.Two port ruptures,two pneumothorax,one revision due to a mechanical problem,one tachyarrhythmia during implantation,and four suture line problems were also recorded in group 2 patients.We also showed that it would be sufficient to evaluate and wash ports once every 2 mo.CONCLUSION Our results robustly confirm that the jugular vein route is safer than the subclavian vein approach for central venous port implantation.展开更多
文摘Subclavian artery aneurysm is a rare phenomenon in the West, but its prevalence is increasingly proportionate to incidence of atherosclerotic disease in the population. It is generally accepted that gold standard care is surgical resection but with limited experience opportunity remains to optimise this. We report on a 66-year-old female arteriopath with an 8 cm intra-thoracic aneurysm of the right subclavian artery, just distal to the brachiocephalic trunk. Lack of a proximal landing zone prohibited endovascular repair thus we utilised the anterior transcervical approach described by Dartevelle. This approach provided excellent visualisation of the aneurysm, along with right vagus and phrenic nerves, facilitating proximal and distal control and subsequent decompression. Post operative recovery was swift and not marred by substantial pain or inhibition of chest wall mechanics, associated with median sternotomy and thoracotomy incisions usually advocated for such aneurysms. As such we purport this approach to offer excellent operative exposure for this increasing disease burden, with less morbidity associated than the currently accepted approach, representing an advance in the management of this condition.
文摘Penetrating injuries to the subclavian arteries as well as post traumatic pseudoaneurysm involving Subclavian artery (SCA) are very much uncommon. We present one case of a 21 year-old male sustained a physical assault with a <span>post stab injury left subclavian artery pseudoaneurysm. He was referred to ou</span>r facility, two days after sustaining a penetrating chest trauma over left i<span><span><span style="font-family:;" "="">n</span></span></span><span><span><span style="font-family:;" "="">frac<span>lavicular area of the chest. The presentation, diagnostic procedures and surg</span>ical approach for management of this very rare injury are discussed.</span></span></span>
文摘BACKGROUND Although the number of patients who need central venous ports for permanent vascular access is increasing,there is still no“gold standard”for the implantation technique.AIM To identify the implantation technique that should be favored.METHODS Two hundred central venous port-implanted patients in a tertiary hospital were retrospectively evaluated.Patients were assigned into two groups according to the access method.The first group comprised patients whose jugular veins were used,and the second group comprised patients whose subclavian veins were used.Groups were evaluated regarding age,sex,application side,primary diagnosis,active follow-up period in the hospital,chemotherapy agents administered,number of complications,and the Clavien-Dindo severity score.The distribution of the variables was tested with the Kolmogorov-Smirnov test and the Mann-Whitney U test.Theχ^(2) test was used to analyze the variables.RESULTS There was no statistically significant difference between the groups regarding age,sex,side,number of chemotherapy drugs,and duration of port usage(P>0.05).Only 2 patients in group 1 had complications,whereas in group 2 we observed 19 patients with complications(P<0.05).No port occlusion was found in group 1,but the catheters of 4 patients were occluded in group 2.One port was infected in group 1 compared to three infected ports in group 2.Two port ruptures,two pneumothorax,one revision due to a mechanical problem,one tachyarrhythmia during implantation,and four suture line problems were also recorded in group 2 patients.We also showed that it would be sufficient to evaluate and wash ports once every 2 mo.CONCLUSION Our results robustly confirm that the jugular vein route is safer than the subclavian vein approach for central venous port implantation.
