Lusory Artery - random finding without further implications or important challenge which conditions treatment strategy.

Transcription

1 Lusory Artery - random finding without further implications or important challenge which conditions treatment strategy. Poster No.: C-2118 Congress: ECR 2014 Type: Authors: Keywords: DOI: Scientific Exhibit H. Kozubek, A. Lisowska, M. Januszewicz; Warszawa/PL Dissection, Aneurysms, Stents, Angioplasty, CT-Angiography, Catheter arteriography, Interventional vascular, Cardiovascular system, Arteries / Aorta /ecr2014/C-2118 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 7

2 Aims and objectives Aberrant right subclavian artery (ARSA) is the most common aberration of aortic arch with an incidence of 1 to 2% and it is widely known to be associated with development of an aneurysm in approximately 3-8% of these patients (1)(2)(3). Patients with ARSA may require surgical or endovascular treatment in some cases. ARSA may become symptomatic by causing "dysphagia lusoria" (4). In patients undergoing endovascular treatment ARSA is a random finding. The aim of the study was to evaluate problems that must be considered when patient with ARSA undergo endovascular treatment, especially TEVAR. Images for this section: Fig. 1: A,B - ARSA - incidental finding Page 2 of 7

3 Fig. 2: A - ARSA in DAA, B - ARSA in RAA Page 3 of 7

4 Methods and materials Contrast-enhanced spiral-ct of the thorax was performed with single-breath-hold technique. 16 raw Light Speed GE equipment was used. We have searched around the database of CT lab of SP CSK for patients with diagnosis of lusory artery. According to data from the referral we divided patients into two groups: Group A - Patients without vascular diseases, where the diagnosis of LA was accidental. Group B - Patients with vascular disease - aortic aneurysm - AA, dissecting aortic aneurysm - DAA, pseudoaneursym - PA, lusory artery aneurysm - LAA, ruptured aortic aneurysm RAA. Results We found 47 patients with ARSA diagnosis, 34 (72%) in group A, 13 (28%) in group B. There were no further clinical implications of ARSA presence in the group A. In the group B ARSA presence has an impact on the treatment approach in 5 of 13 (38%) cases - patients with: DAA was treated with stentgraft implantation and subsequent axillary-axillary artery bypass, PA was treated with stentgraft implantation and subsequent carotid-subclavian artery bypass, RAA was treated with stentgraft implantation and subsequent carotid-subclavian artery bypass and two patients with LAA treated with stentgraft implantation and subsequent carotid-axillary artery bypassing. Images for this section: Page 4 of 7

5 Fig. 3: ARSA in DAA after treatment. A - aortic stent-graft, B - aortic stent-graft + carotidsubclavian by-pass Fig. 4: ARSA in RAA after treatment. A - aortic stent-graft, B - carotid-subclavian by-pass Page 5 of 7

6 Conclusion LA presence is rare and often asymptomatic even in patients with cardiovascular diseases. In some cases can cause dysphagia lusoria (4). Nonetheless when patient undergo endovascular treatment ARSA could be important when deciding strategy of intervention. Main problem in endovascular approach is exclusion of ARSA from circulation causing ischemia in right upper limb. Widely discussed hybrid techniques - endovascular stent implantation with subsequent bypassing (5)(6)(7)(8) could be the best options for these patients. Still the group of patients treated in that way is not so large and there is a need of further study in this field. Personal information References 1. Richardson JV, Doty DB, Rossi NP, Ehrenhaft JL. Operation for aortic arch anomalies Ann Thorac Surg 1981;31: Stone WM, Ricotta JJ 2nd, Fowl RJ, Garg N, Bower TC, Money SR. Contemporary management of aberrant right subclavian arteries. Ann Vasc Surg 2011;25: Lee JH, Ko YG, Yoon YN, Choi D, Lee DY. Hybrid treatment for thoracic aortic aneurysm combined with aberrant right subclavian artery. Korean Circ J. 2013; January;43(1): Janssen M, Baggen MGA, Veen HF, et al. Dysphagia lusoria: clinical aspects, manometric findings, diagnosis, and therapy Am J Gastroenterol 2000;95: Corral JS, Zuniga CG, Sanchez JB, et al. Treatment of an aberrant right subclavian artery aneurysm with endovascular exclusion and adjunctive surgical bypass J Vasc Interv Radiol 2003;14: Kopp R, Wizgall I, Kreuzer E, Meimarakis G, Weidenhagen R, Kühnl A, Conrad C, Jauch KW, Lauterjung L. Surgical and endovascular treatment of symptomatic aberrant right subclavian artery (arteria lusoria). Vascular Mar-Apr;15(2): Page 6 of 7

7 7. Corral JS, Zuniga CG, Sanchez JB, et al. Treatment of an aberrant right subclavian artery aneurysm with endovascular exclusion and adjunctive surgical bypass J Vasc Interv Radiol 2003;14: Attmann T, Brandt M, Muller-Hulsbeck S, Cremer J. Two-stage surgical and endovascular treatment of an aneurysmal aberrant right subclavian (lusoria) artery Eur J Cardiothorac Surg 2005;27: Page 7 of 7