Aberrant right subclavian artery (ARSA) is the most common aortic arch anomaly. The estimated incidence is 0.5-2%. They are often asymptomatic, but approximately 10% of people may complain of dysphagia lusoria4 or other compressive symptoms. In ARSA of the Innominate artery, the right subclavian artery arises as its own branch from the aortic arch distal to the origin of the left subclavian artery. Its relationship to the esophagus is variable with 80% posterior to esophagus, 15% between the esophagus and trachea, and 5% anterior to the trachea. There have been very few reports of acute dissection of the aberrant right subclavian artery. We present a new management strategy for symptomatic iatrogenic aberrant right subclavian artery dissection. …show more content…
Physical exam was remarkable for a diminished right radial pulse as well as decreased sensation and motor activity in the right hand. Anticoagulation was started and CTA of the neck and chest was performed. This showed a dissected aberrant right subclavian artery arising as the last major branch of a bovine aortic arch. The dissection was found to extend to the right axillary artery. The right vertebral artery arose from the false lumen. The left vertebral artery had high grade stenosis at its origin. The carotid arteries had no hemodynamically significant stenosis (figure …show more content…
Through a neck incision the right carotid, right subclavian and right vertebral arteries were exposed. The right brachial artery was exposed through a right upper arm incision. Right vertebral artery was transposed to the right common carotid artery. Right common carotid to right brachial artery bypass using 6mm PTFE graft was carried out. A Zenith TX2 thoracic aortic endovascular graft (COOK Medical, Indiana, USA) was then placed using right femoral approach to cover and occlude the origin of the aberrant right subclavian artery. A 7-french sheath was placed through surgically exposed right brachial artery, and an AMPLATZER Vascular Plug II (ST. JUDE MEDICALTM, Minnesota, USA) was placed in the aberrant right subclavian artery close to its origin. Completion angiogram showed no flow through the native right subclavian artery with complete patency of right carotid, right brachial and vertebral arteries (figure 3). The patient had an uneventful recovery with resolution of right arm symptoms and was discharged. At six months post procedure patient continues to be asymptomatic and all vessels except the aberrant right subclavian are
Unit V- Cardiovascular system Subheading: 1. Cyanotic Congenital Heart Diseases 2. Acyanotic Congenital Heart Diseases 3. Acute Rheumatic Fever 4. Rheumatic Heart Disease 5.
No JVD. No cyanosis, clubbing, or edema. 2+ pulses bilaterally at the carotid artery. 1+ pulses bilaterally at radial, DP, and PT arteries. No murmur or change in cardiac status with 1 min of vigorous activity in the office.
Marfans can rupture the inner layers of the aorta which causes dissection that leads to bleeding in the wall of the vessel. Mafans syndrome
Localization of the pain was consistent from the T4 to T5dermatome (on the right anterior, lateral and posterior chest wall). He described the pain as severe stabbing and lancinating with a numeric rating scale (NRS) of 8/10. The patient also reported sleep disturbances due to the pain, which had begun 20 day earlier but had aggravated within the last 1 week. He had a 3-year history of taking anticoagulants for the management of arterial fibrillation. At our pain clinic we prescribed tramadol and low dose pregabalin, but they failed to provide pain relief.
The resected femoral head demonstrated a flattened widespread surface with a flap of articular cartilage and subchondral bone, and the cut section showed a subchondral fracture line parallel to the articular surface (Figure 4A). Histological examination showed repair tissue comprising of marked fracture callus and vascular rich granulation tissue on both sides of the fracture line (Figure 4B). There was no evidence of antecedent osteonecrosis. Histopathologic findings demonstrated that the collapse of his femoral head was caused by a subchondral fracture resulting from acetabular fracture. Figure 4 Histological findings show a subchondral fracture of the femoral head and no evidence of antecedent osteonecrosis.
DOI: 12/17/2011. Patient is a 52-year-old male pasteurizer machine operator who sustained injury when he slipped and fell while climbing up the ladder. Per OMNI, the patient has undergone right carpal tunnel release and decomp0ression on 11/06/15, epidural steroid injection, gastro endoscopy and left knee surgery. Per the AME report dated 6/2/15 stated that future medical care includes orthopedic consultations for exacerbation, as well as short courses of physical therapy and/or prescription medication. Repeat surgery should be left open for the right wrist, as well as the possibility of surgical intervention for the bilateral shoulders and bilateral knees.
Thoracic Aortic Aneurysm is an abnormal bulging or ballooning of the portion of the aorta the passes through the chest. The most common cause is atherosclerosis, or hardening of the arteries(AHA) Risk factors may include, aging, genetic conditions such as Marfan and Loeys-Dietz Syndrome, Inflammation of the aorta, injury from falls or other trauma, and or, Syphilis. A patient with Thoracic Aortic Aneurysm may not have or experience any symptoms until it begins to leak blood into the nearby tissue or expand. There are many symptoms such as hoarseness, swallowing problems, swelling in neck, chest or upper back pains, and many more to include.
There is deltoid detachment on the lateral aspect of the acromion, well-healed arthroscopic and an extended lateral incision of the acromion likely related to the index surgery in 2001. The shoulder has a marked capsular pattern stabilizing scapula, 25 to 30 of abduction, 40 to 45 of flexion, and external rotation to 5. She internally rotates to L5 left flank. Coarse crepitate is palpable through the limited motion arc. Both pain and weakness is demonstrated in resisted internal and external rotation from neutral and attempts to isolate the calf away from the
Aortic Dissection: Hemiarch Versus Total Arch Replacement Taylor Aubin Sinclair Community College October 1, 2015 Aortic dissection is a life threatening condition in which the intima, the inner most layer, of the aorta tears. As the blood flows through the aorta it rushes through this tear resulting in dissection of the intima from the media, the middle layer of the aorta. This unfortunate condition is often fatal if the newly created false lumen ruptures through the aortic wall.
The oxygenated blood passes through the bicuspid valve and into the left ventricle where it will be ejected into the largest artery of the body known as the aorta via the aortic valve. The ejected blood will then be distributed throughout the body using a network of blood vessels. The distribution of blood throughout the body occurs via the four divisions of the aorta; the ascending aorta, the aortic arch, the thoracic aorta and the abdominal aorta. Beyond the aortic valve within the ascending aorta, there ate miniature openings called coronary ostia which arise from the left and right coronary arteries that supply blood to the heart
The relative absence of recent data reflects the lack of enthusiasm for the use of this imaging modality for VAD in present day. More recent studies suggest that ultrasound is not necessary for the diagnosis of VAD but may offer more information on the possible development of stroke16. These studies suggest that ultrasound could be put to better use in a follow-up scenario – monitoring progress and recanalization. With regard to the of the pitfalls of ultrasound diagnosis of VAD, investigators found that ultrasonography is made difficult by the course of the VA as it becomes invisible to ultrasound as through the foramen transversarium14 – making it impossible to effectively image the whole course of the VA.
Blood will flow from the left ventricle into the right ventricle with this particular defect. The defect causes increased blood flow into the lungs and can eventually result in pulmonary hypertension. Pulmonary hypertension will causes damage to the small blood vessels in lungs progressively through time. This is known as pulmonary vascular disease. As the damage progresses, pulmonary hypertension will increase and the small blood vessels become thickened and blocked affecting the flow of blood.
Sometimes, the great arteries get reversed. This is called transposition. The pulmonary artery is connected to the left side of the heart (instead of the right). The aorta is connected to the right side (instead of the left). This is a problem because the right side of the heart pumps blood to the lungs.
The left subclavian artery branches directly from the aorta, the largest artery in the body. The aorta curves above the heart before running down the front of the backbone. “The brachiocephalic artery, also known as the brachiocephalic trunk or innominate artery, is much shorter than the aortic arch and splits into two to form the right subclavian artery and the right common carotid
The heart pumps blood to all the important areas throughout the body through an artery known as the aorta (which is the main artery which leads from the body). A thick layer of muscle called the septum which separates both sides of the heart. The deoxygenated blood exits through the right ventricle of the heart