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THE JOURNAL OF CARDIOVASCULAR SURGERY

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The Journal of Cardiovascular Surgery 2000 June;41(3):463-7

lingua: Inglese

Transcatheter embolization of mycotic aneurysm of the subclavian artery with metallic coils

Mori K., Saida Y., Kuramoto K. *, Anno I., Yoshioka H., Irie T., Itai Y.

From the Department of Radiology Tsukuba University Hospital, Tsukuba, Japan
*Department of Radiology National Hospital Tokyo Disaster Medical Center Tachikawa, Japan


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Mycotic aneu­rysms of the sub­cla­vian ­artery are ­rare. This ­report ­describes an expe­ri­ence of 2 ­rare cas­es in ­which trans­cath­et­er embol­iza­tion ­with metal­lic ­coils was per­formed for the man­age­ment of ­these ­lesions alter­na­tive to sur­gery.
Two ­patients who had ­been treat­ed ­with chem­o­ther­a­py for malig­nant neo­plasms ­were diag­nosed as hav­ing mycot­ic aneu­rysms of the ­left sub­cla­vian ­artery. The caus­es of ­these ­lesions ­were pre­sumed to be the inva­sion of the arte­ri­al ­wall by the pul­mo­nary ­abscess in ­case 1, and ­wound infec­tion ­after place­ment of the res­er­voir for intra­ar­te­ri­al chem­o­ther­a­py in ­case 2. In ­both cas­es, prox­i­mal and dis­tal ­sites of the aneu­rysm ­were embol­ized ­with metal­lic ­coils. In ­case 1, the ver­te­bral ­artery was ­also embol­ized ­with Guglielmi detach­able ­coils to ­avoid ret­ro­grade ­blood ­flow.
Both aneu­rysms ­were com­plete­ly occlud­ed by a sin­gle embol­iza­tion. In ­case 1, ­although weak­ness and pares­the­sia of the ­left ­hand ­remained, ­lethal hemop­ty­sis due to aneu­rys­mal fis­tul­iza­tion to the ­lung paren­chy­ma ­ceased. In ­case 2, no neu­ro­log­i­cal def­i­cit ­except for ­mild pares­the­sia in the ­left ­thumb had ­been ­observed. Both ­patients ­died of pri­mary ­disease 10 and 5 ­months ­after the pro­ce­dure.
Transcatheter embol­iza­tion is tech­ni­cal­ly fea­sible and effec­tive ­enough to ­treat the mycot­ic aneu­rysm of the sub­cla­vian ­artery ­even in the sit­u­a­tion in ­which the sur­gi­cal ­option ­seems to be dif­fi­cult or ­risky.

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