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      Aneurisma de la arteria subclavia izquierda: causa infrecuente de masa pulmonar superior Translated title: Left subclavian artery aneurysm: uncommon cause of an upper lung mass

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          Abstract

          El aneurisma de la arteria subclavia es una entidad infrecuente. Su causa más frecuente es la arteriosclerosis. Sus manifestaciones clínicas suelen ser escasas y generalmente se deben a compresión de estructuras vecinas o a fenómenos isquémicos, embólicos o menos frecuentemente a ruptura del mismo. El diagnóstico se consigue mediante una arteriografía o tomografía computarizada. El tratamiento implica la resección quirúrgica o la embolización del mismo. Presentamos el caso de un paciente con un aneurisma de la arteria subclavia izquierda y revisamos los aspectos más importantes de esta patología.

          Translated abstract

          Subclavian artery aneurysm is an uncommon condition. Usually is arteriosclerotic in origin. Its clinical features are scarce and generally are due to compression of the neighbourhood structures or ischemic, embolic or, less frequently, rupture of it. Diagnosis is performed by an arteriography or a computed tomography scan. Treatment includes the surgical reection or the embolization. We report the case of a patient with a left subclavian artery aneurysm and review the most important clinical features of this entity.

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          Aneurysm of aberrant subclavian artery with a review of the literature.

          Aneurysms arising in an aberrant subclavian artery are rare but constitute a potentially lethal condition that can be treated successfully when appropriately identified. Virtually all patients have a superior mediastinal mass that may be asymptomatic, but usually patients have symptoms of dysphagia, chest pain, or shortness of breath. An accurate diagnosis can now be made noninvasively with computerized tomography. The presence of an aneurysm of an anomalous subclavian artery is an indication for surgical resection. Resection of the aneurysm may be approached through either a right or left thoracotomy. Reestablishment of continuity of flow to the right subclavian artery decreases the risk of ischemia of the extremities and prevents development of the subclavian steal syndrome. Reestablishment of flow to the right subclavian artery is more easily performed through a right thoracotomy incision but this approach limits control of the aorta at a possibly treacherous connection between aorta and aneurysm. In such circumstances a preliminary extra-anatomic reconstitution of flow to the right subclavian artery followed by a left thoracotomy may be preferable. A 67-year-old woman is described who had resection and grafting of an aneurysm in an aberrant right subclavian artery together with a review of the literature and a discussion of problems in the management of patients with this condition.
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            Diagnosis and treatment of subclavian artery aneurysms.

            The diagnostic features and operative results in 13 patients with subclavian artery aneurysms were analysed. Symptoms related to subclavian artery aneurysms were present in seven patients, whereas six patients were asymptomatic and the aneurysm was discovered incidentally on chest X-ray. Angiography was the most valuable diagnostic examination and was also necessary in planning the operation. A correct preoperative diagnosis was made in five of six patients with computed tomography. Resection of the aneurysm was performed in nine and aneurysmal exclusion in the latest four patients. Direct reconstruction was used in nine and in four cases an extra-anatomic carotico-subclavian bypass was performed. Postoperative complications arose in two symptomatic and in four asymptomatic patients (46%: two strokes, two wound infections demanding extirpation of the prosthesis in one patient, two pareses of the recurrent nerve and one postoperative haemorrhage). Operative mortality was one patient. Follow-up data was available for all patients for periods of 6 months to 14 years. The vascular graft was patent in all patients. The authors conclude that subclavian artery aneurysm must be included in the differential diagnosis of all obscure upper mediastinal masses as seen on the chest X-ray and examined with CT and angiography. Exclusion of the aneurysm with extra-anatomical reconstruction is technically easier and gives the same postoperative long-term results as resection of the aneurysm and direct reconstruction. A relatively high complication rate after operation on asymptomatic subclavian aneurysms indicates a need for re-evaluation of operative indications in asymptomatic patients.
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              Multiple aneurysms and aortic dissection: an unusual manifestation of Marfan's syndrome

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                ami
                Anales de Medicina Interna
                An. Med. Interna (Madrid)
                Arán Ediciones, S. L. (, , Spain )
                0212-7199
                February 2001
                : 18
                : 2
                : 40-41
                Affiliations
                [01] Pozoblanco Córdoba orgnameHospital Valle de los Pedroches
                [02] Marbella Málaga orgnameHospital Costa del Sol orgdiv1Servicio de Medicina Interna orgdiv2Unidad de Neumología
                Article
                S0212-71992001000200007
                10.4321/s0212-71992001000200007
                214d167b-ea1c-4be5-b857-ca6b13ec4627

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 10, Pages: 2
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                SciELO Spain


                Aneurisma,Arteria subclavia,Masa pulmonar,Aneurysm,Subclavian artery,Pulmonary mass

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