tailieunhanh - Báo cáo y học: "An alternative surgical approach to subclavian and innominate stenosis: a case series"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Wertheim cung cấp cho các bạn kiến thức về ngành y đề tài: An alternative surgical approach to subclavian and innominate stenosis: a case series. | Khalil and Nashef Journal of Cardiothoracic Surgery 2010 5 73 http content 5 1 73 JOTS JOURNAL OF CARDIOTHORACIC SURGERY CASE REPORT Open Access An alternative surgical approach to subclavian and innominate stenosis a case series Amina Khalil1 Samer AM Nashef2 Abstract We report three cases of symptomatic stenosis of the great vessels or supra-aortic trunks successfully treated surgically with aorto-subclavian and aorto-innominate bypass. Two were performed via manubriotomy and a third case via standard median sternotomy because of concomitant coronary revascularisation. There was complete symptomatic relief on follow-up and radiological imaging confirmed good flow in the grafts and post-stenotic arteries. Background Like other arteries the innominate left common carotid and subclavian arteries or supra-aortic trunks SATs can be affected by atherosclerosis. Many patients with SAT disease are asymptomatic but some may present with symptoms of cerebral or limb ischaemia. The use of endovascular intervention for SAT occlusive disease is increasing but open surgical reconstruction remains an effective treatment option with good long term results. Although the cervical approach for the treatment of SAT disease has proven to be a good surgical option over the years a transthoracic approach can provide durable results particularly when the disease process affects all three trunks or involves long segments 1 . The morbidity associated with the transthoracic route may be reduced by using a less invasive approach such as manubriotomy. A short summary of clinical presentation the surgical technique employed and the outcomes forms the basis of the present case series. Case 1 A 64-year-old male presented with frequent episodes of dizziness after myocardial infarction. Ambulatory 24hour cardiac monitoring showed periods of asystole and a dual chamber pacemaker was implanted. The patient remained symptomatic with the same frequency of dizzy spells .