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Kardiologia Polska Mar 2021
Topics: Aorta, Thoracic; Brachiocephalic Trunk; Carotid Artery, Common; Humans; Scimitar Syndrome
PubMed: 33599458
DOI: 10.33963/KP.15818 -
Journal of Vascular Surgery Cases and... Sep 2023We describe a case of simultaneous ascending aortobifemoral and right common carotid artery bypass to treat a symptomatic brachiocephalic artery and juxtarenal chronic...
We describe a case of simultaneous ascending aortobifemoral and right common carotid artery bypass to treat a symptomatic brachiocephalic artery and juxtarenal chronic total occlusion in a 68-year-old female patient with unfavorable characteristics for endovascular and standard aortofemoral procedures. Mid-term follow-up revealed sustained remission of symptoms, quality of life quality of life improvement, and patent bypass grafts. In highly selected patients, this solution can be useful when treating other intrathoracic diseases, as well as allowing the simultaneous revascularization of two remote arterial beds.
PubMed: 37635741
DOI: 10.1016/j.jvscit.2023.101203 -
Arteriosclerosis, Thrombosis, and... Sep 2020Evidence from preclinical and clinical studies has demonstrated that myocardial infarction promotes atherosclerosis progression. The impact of focal vascular...
OBJECTIVE
Evidence from preclinical and clinical studies has demonstrated that myocardial infarction promotes atherosclerosis progression. The impact of focal vascular inflammation on the progression and phenotype of remote atherosclerosis remains unknown. Approach and Results: We used a novel knockout mouse model of sustained arterial inflammation, initiated by mechanical injury in the abdominal aorta. Using serial in vivo molecular MRI and ex vivo histology and flow cytometry, we demonstrate that focal arterial inflammation triggered by aortic injury, accelerates atherosclerosis in the remote brachiocephalic artery. The brachiocephalic artery atheroma had distinct histological features including increased plaque size, plaque permeability, necrotic core to collagen ratio, infiltration of more inflammatory monocyte subsets, and reduced collagen content. We also found that arterial inflammation following focal vascular injury evoked a prolonged systemic inflammatory response manifested as a persistent increase in serum IL-6 (interleukin 6). Finally, we demonstrate that 2 therapeutic interventions-pravastatin and minocycline-had distinct anti-inflammatory effects at the plaque and systemic level.
CONCLUSIONS
We show for the first time that focal arterial inflammation in response to vascular injury enhances systemic vascular inflammation, accelerates remote atheroma progression and induces plaques more inflamed, lipid-rich, and collagen-poor in the absence of ischemic myocardial injury. This inflammatory cascade is modulated by pravastatin and minocycline treatments, which have anti-inflammatory effects at both plaque and systemic levels that mitigate atheroma progression.
Topics: Animals; Anti-Inflammatory Agents; Aortitis; Atherosclerosis; Brachiocephalic Trunk; Collagen; Disease Models, Animal; Disease Progression; Inflammation Mediators; Interleukin-6; Lipid Metabolism; Male; Mice, Knockout, ApoE; Minocycline; Necrosis; Plaque, Atherosclerotic; Pravastatin; Time Factors
PubMed: 32673527
DOI: 10.1161/ATVBAHA.120.314387 -
Medicine Aug 2016Bronchial artery aneurysm (BAA) is an uncommon but potentially life-threatening disease, and multiple BAAs are even rarer. Clinically, the tortuous and short neck of a... (Review)
Review
BACKGROUND
Bronchial artery aneurysm (BAA) is an uncommon but potentially life-threatening disease, and multiple BAAs are even rarer. Clinically, the tortuous and short neck of a BAA may present significant challenges for invasive intervention.
METHODS
This report describes the detailed process of diagnosis and treatment and includes a literature review of the etiology, clinical presentation, and therapeutic management of BAA.
RESULTS
A rare case of multiple BAAs, with one having an inflow artery arising from the brachiocephalic trunk, was referred to our hospital. The patient was successfully treated with coil embolization and brachiocephalic artery stent placement. In addition, we conducted a literature review involving 63 cases of BAA. BAA was most commonly associated with bronchiectasis and was located predominantly in the mediastinum. There was no significant difference between the diameters of the ruptured aneurysms and those of the nonruptured aneurysms (P = 0.115). Transcatheter arterial embolization was the most commonly adopted technique to treat BAA, while thoracic aortic endovascular repair was selected if the neck between the aneurysm and the aorta was short. Subgroup analysis suggested that patients with > 1 BAA were significantly more likely to be female than male (χ test, P = 0.034).
CONCLUSION
Transcatheter coil embolization combined with stent placement could be a reasonable treatment option for BAAs with a tortuous and short neck. According to our literature review, patients with multiple BAAs display distinctive clinical characteristics compared with patients with a single BAA.
Topics: Aneurysm; Brachiocephalic Trunk; Bronchial Arteries; Embolization, Therapeutic; Endovascular Procedures; Female; Humans; Middle Aged; Stents; Tomography, X-Ray Computed
PubMed: 27583854
DOI: 10.1097/MD.0000000000004461 -
Jornal Vascular Brasileiro 2018The median thoracotomy is an access incision made longitudinally through the sternum and variants can be subdivided into total vertical and partial upper or partial...
The median thoracotomy is an access incision made longitudinally through the sternum and variants can be subdivided into total vertical and partial upper or partial lower vertical incisions. In surgical practice, using a partial median sternotomy is an alternative option that causes less surgical aggression. The brachiocephalic artery is one of the thoracic vessels most often affected in traumas and it can be accessed via a median sternotomy. This report describes use of an upper partial sternotomy to provide access in a case of traumatic iatrogenic injury of the brachiocephalic trunk.
PubMed: 30377425
DOI: 10.1590/1677-5449.008517 -
Gland Surgery Dec 2016Non-recurrent laryngeal nerve (NRLN) is a rare anatomical variant (0.3-6%) that is associated with some arterial abnormalities (absence of the brachiocephalic trunk and...
BACKGROUND
Non-recurrent laryngeal nerve (NRLN) is a rare anatomical variant (0.3-6%) that is associated with some arterial abnormalities (absence of the brachiocephalic trunk and presence of a right aberrant subclavian lusorian artery). The availability of a preoperative diagnosis of NRLN may reduce the risk of nerve injuries. Preoperative ultrasonography (US) has been suggested as a reliable diagnostic tool to detect the arterial abnormalities associated with NRLN, but the literature is relatively scarce. This paper was aimed to review the literature, in order to offer an up to-date on this technique and its results.
METHODS
A web search, focusing on humans, was performed by PubMed database, including papers published up to August 2016, using the key words "ultrasonography" AND "non-recurrent laryngeal nerve" or "nonrecurrent laryngeal nerve".
RESULTS
Eight papers, including 3,740 patients who underwent neck US for the detection of NRLN were selected. Only five studies focused on the preoperative use of US. The incidence of NRLN varied between 0.4% and 1.94%. The sensitivity and specificity varied between 99-100% and 41-100%, respectively.
CONCLUSIONS
US is a simple, non-invasive and cost-effective method to detect NRLN, also if its accuracy is not absolute. It may be used preoperatively and to prevent the intraoperative nerve damage, since the risk of NRLN palsies is significantly reduced when a preoperative diagnosis is available.
PubMed: 28149804
DOI: 10.21037/gs.2016.11.07 -
RMD Open Aug 2022Giant cell arteritis (GCA) with the involvement of extracranial vessels is increasingly coming into focus. Isolated aortic involvement in the acute phase of GCA is...
Distribution patterns of arterial affection and the influence of glucocorticoids on F-fluorodeoxyglucose positron emission tomography/CT in patients with giant cell arteritis.
BACKGROUND
Giant cell arteritis (GCA) with the involvement of extracranial vessels is increasingly coming into focus. Isolated aortic involvement in the acute phase of GCA is probably more frequent than estimated because only a minority of patients show typical symptoms. F-fluorodeoxyglucose positron emission tomography/CT (PET/CT) is a reliable imaging tool to diagnose patients with extracranial GCA. The aim of this retrospective study was to quantify arterial involvement at the onset of a newly diagnosed GCA by PET/CT and to evaluate the influence of glucocorticoid (GC) treatment on the diagnostic performance of this imaging technique.
METHODS
The study included 60 patients with GCA at the onset of a GCA. All patients had undergone a PET/CT scan. 44 patients were GC naïve and 16 patients received GC.
RESULTS
The most affected arteries were the ascending aorta (72%), followed by the brachiocephalic trunk (62%), aortic arch (60%) and descending aorta (60%). The aorta and its branches showed an inflammatory involvement in 83.3% of patients. A singular affection of the aorta and the brachiocephalic trunk was revealed in 20% of cases. GC-naïve patients (95.5%) had more frequently affected arteries compared with GC-treated patients (50%).
CONCLUSION
Our study showed the frequent involvement of the thoracic aorta and brachiocephalic trunk in patients with GCA using PET/CT. Since these vascular compartments cannot be visualised by ultrasound, we advocate screening imaging of the aorta with PET/CT when GCA is suspected. Because the use of GC is associated with a marked decrease in the inflamed vascular segment in GCA, PET/CT should be performed as soon as possible.
Topics: Arteries; Fluorodeoxyglucose F18; Giant Cell Arteritis; Glucocorticoids; Humans; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Retrospective Studies
PubMed: 35953239
DOI: 10.1136/rmdopen-2022-002464 -
Journal of the American Heart... Aug 2021Background The pathogenesis of transposition of the great arteries (TGA) as a congenital heart defect of the outflow tract with discordant ventriculoarterial connections...
Is Transposition of the Great Arteries Associated With Shortening of the Intrapericardial Portions of the Great Arterial Trunks? An Echocardiographic Analysis on Newborn Infants With Simple Transposition of the Great Arteries to Explore an Animal Model-Based Hypothesis on Human Beings.
Background The pathogenesis of transposition of the great arteries (TGA) as a congenital heart defect of the outflow tract with discordant ventriculoarterial connections remains an enigma. TGA usually have parallel great arteries suggesting that deficient torsion of the embryonic arterial heart pole might cause discordant ventriculoarterial connections. It has been speculated that deficient elongation of the embryonic outflow tract might prevent its normal torsion resulting in TGA. The aim of our study was to clarify whether the intrapericardial portions of the great arteries in human patients with TGA might be indeed shorter than in normal hearts. Methods and Results Thirty-four newborns with simple TGA and 35 newborns with normal hearts were analyzed by using images of the outflow tract in their echocardiograms and the following defined lengths of the great arteries were measured: aortic length 1, (AoL-1) and aortic length 2 (AoL-2) = distance between left and right aortic valve level and origin of the brachiocephalic artery, respectively. Pulmonary trunk length 1 (PTL-1) and pulmonary trunk length 2 (PTL 2) = distance between left and right pulmonary valve level and origin of left and right pulmonary artery, respectively. All measurements of the AoL were significantly shorter in TGA compared to normal hearts (AoL-1: 1.6±0.2 versus 2.05±0.1; <0.0001; AoL-2: 1.55±0.2 versus 2.13±0.1; <0.0001). With regard to the pulmonary trunk (PT), PTL-1 and PTL-2 were found to be shorter and longer, respectively, in TGA compared with normal hearts, reflecting the differences in the spatial arrangement of the PT between the 2 groups as in TGA the PT is showing a mirror image of the normal anatomy. However, the overall length of the PT between the 2 groups did not differ. Conclusions Our data demonstrate that, compared with normal newborns, the ascending aorta is significantly shorter in newborns with TGA whereas the overall length of the PT does not differ between the 2 groups. This finding is in accord with the animal model-based hypothesis that TGA may result from a growth deficit at the arterial pole of the embryonic heart.
Topics: Anatomic Landmarks; Animals; Aorta; Brachiocephalic Trunk; Cross-Sectional Studies; Echocardiography; Female; Humans; Infant, Newborn; Male; Predictive Value of Tests; Prospective Studies; Pulmonary Artery; Retrospective Studies; Transposition of Great Vessels
PubMed: 34278802
DOI: 10.1161/JAHA.120.019334 -
Journal of the American College of... Dec 1988Congenital arteriovenous fistulas presenting in the newborn period pose difficult diagnostic problems and simulate structural heart disease. Angiocardiography, when...
Congenital arteriovenous fistulas presenting in the newborn period pose difficult diagnostic problems and simulate structural heart disease. Angiocardiography, when performed, demonstrates enlarged brachiocephalic vessels and rapid cerebral venous return. The value of echocardiographic imaging and measurement of the aortic arch and brachiocephalic vessels, and evaluation of the Doppler flow profile in these vessels as a means of making a rapid diagnosis of cerebral or thoracic arteriovenous fistula, was therefore assessed in 10 infants with these diagnoses seen over a 4 year period (1983 to 1987). Twenty-nine infants (median age 6 weeks) undergoing two-dimensional echocardiography but with no significant lesions were prospectively selected as controls. Nine of the 10 patients had congestive heart failure at presentation (mean age 2 days). A cranial bruit was heard in three and arteriovenous fistula was suspected in five patients. Aortic arch segments and brachiocephalic vessel dimensions expressed as ratios of the abdominal aorta showed significantly larger values in patients for the ascending aorta (p = 0.01), innominate artery (p less than 0.001), right and left subclavian arteries (p less than 0.001) and left common carotid artery (p less than 0.05). The thoracic descending aorta was, however, significantly smaller in patients (p less than 0.002). Retrograde diastolic Doppler flow in the descending aorta proximal to the ductus arteriosus and anterograde diastolic flow with a mean spectral flow-time integral 27% of systolic were present in patients only, whereas Doppler diastolic flow in brachiocephalic vessels, present in 5 of 29 control infants, was less than 15% of systolic flow and not accompanied by dilation of these vessels.(ABSTRACT TRUNCATED AT 250 WORDS)
Topics: Aorta, Thoracic; Arteriovenous Malformations; Brachiocephalic Trunk; Cerebral Angiography; Diastole; Echocardiography; Humans; Infant; Infant, Newborn; Intracranial Arteriovenous Malformations; Ultrasonography
PubMed: 3057034
DOI: 10.1016/s0735-1097(88)80021-4 -
Science Progress 2023Guidewire occasionally creates a loop-like appearance between the right subclavian artery and brachiocephalic artery when performing coronary angiography (CAG) with...
A possible mechanism and predictors of forming looped guidewire between the right subclavian and brachiocephalic artery during coronary angiography with right radial artery access: An original paper.
OBJECTIVES
Guidewire occasionally creates a loop-like appearance between the right subclavian artery and brachiocephalic artery when performing coronary angiography (CAG) with right radial artery (RtRA) access. We called this occurrence a looped guidewire at the brachiocephalic artery (looped GW at BA). It is associated with difficulties in catheter manipulation. This study aimed to assess the predictors of forming a looped GW at the BA.
METHODS
We examined 175 (mean age, 71.3 ± 9.5 years; 74.9% men) consecutive patients who underwent elective CAG with the RtRA access. Looped GW at the BA was defined as a loop-like appearance of the 0.035-inch GW between the right subclavian and brachiocephalic artery on a frontal view or left anterior oblique. To identify the predictors of looped GW at BA, patient characteristics and examination data obtained before CAG were compared between patients with and without looped GW at the BA.
RESULTS
The prevalence of looped GW at BA was 10.9%. The cardio-ankle vascular index (CAVI), which reflects arterial stiffness, was significantly different in patients with or without looped GW at BA (9.8 ± 1.0 vs. 8.9 ± 1.5, p= 0.0092). The area under the receiver-operating characteristic curve of CAVI to predict looped GW at BA was 0.745, with 0.94 sensitivity and 0.57 specificity in a cutoff point of CAVI ≥9.0.
CONCLUSIONS
Looped GW at BA can be ruled out by CAVI and is associated with high arterial stiffness.
Topics: Male; Humans; Middle Aged; Aged; Aged, 80 and over; Female; Coronary Angiography; Radial Artery; Brachiocephalic Trunk
PubMed: 37960890
DOI: 10.1177/00368504231213801