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Yutaka Okita - One of the best experts on this subject based on the ideXlab platform.

  • graft replacement of kommerell diverticulum and in situ Aberrant Subclavian Artery reconstruction
    The Annals of Thoracic Surgery, 2019
    Co-Authors: Yuki Ikeno, Yojiro Koda, Koki Yokawa, Yasuko Gotake, Soichiro Henmi, Hidekazu Nakai, Takashi Matsueda, Takeshi Inoue, Hiroshi Tanaka, Yutaka Okita
    Abstract:

    Background This study aimed to evaluate the early and long-term outcomes of graft replacement of Kommerell diverticulum and in situ reconstruction of Aberrant Subclavian arteries in adults. Methods Seventeen patients, 6 symptomatic and 11 with right aortic arch, underwent open repair of Kommerell diverticulum from October 1999 to September 2017. Two of these patients underwent open surgical treatment of a ruptured aneurysm. Surgical indications were dilatation of Kommerell aneurysm (n = 9), the presence of a nondissecting aneurysm with Kommerell diverticulum (n = 6), acute type A aortic dissection (n = 1), and complicated acute type B aortic dissection (n = 1). Ten patients underwent total arch replacement and descending aorta replacement through a thoracotomy. Five patients underwent arch replacement and in situ reconstruction through a median sternotomy. All patients except 1 also underwent in situ reconstruction of their Aberrant Subclavian Artery. Results In-hospital death occurred in 1 patient (5.9%), who underwent total arch replacement for a ruptured aneurysm. Permanent neurologic deficit did not occur in any patient, whereas transient neurologic deficit occurred in 2 patients (11.8%). Five- and 10-year survival rates were 85.2 ± 9.8% and 75.8 ± 12.5%, respectively. There was no symptom recurrence or stenosis of the reconstructed Subclavian arteries. Conclusions Early outcomes of graft replacement of Kommerell diverticulum and in situ Aberrant Subclavian Artery reconstruction were acceptable. As for long-term outcomes, symptomatic improvement and an excellent patency rate among reconstructed Aberrant Subclavian arteries suggest that in situ surgical repair is an effective treatment option.

  • surgical treatment for kommerell s diverticulum
    The Journal of Thoracic and Cardiovascular Surgery, 2006
    Co-Authors: Takeyoshi Ota, Kenji Okada, Shuichiro Takanashi, Shin Yamamoto, Yutaka Okita
    Abstract:

    Objective Kommerell's diverticulum, which is a rare condition, is a congenital abnormality of the aortic arch. The strategy of surgical treatment for Kommerell's diverticulum has not been established. Methods Between 1994 and 2004, 6 patients underwent surgery for Kommerell's diverticulum at our institute. Diagnoses included right aortic arch with Aberrant left Subclavian Artery in 4 patients and left aortic arch with Aberrant right Subclavian Artery in 2 patients. Indications for surgery were dilatation of Kommerell's aneurysm (n = 4) and dysphagia (n = 2). One patient underwent total arch replacement through the median sternotomy plus right thoracotomy. Five patients underwent replacement of the descending aorta and reconstruction in situ (n = 4) or ligation (n = 1) of the stenotic Aberrant Subclavian Artery through the right (n = 3) or left (n = 2) thoracotomy. Results There were no patient deaths or patients who required rehospitalization. Mediastinitis occurred in 1 patient. This patient required mediastinal drainage and an omentopexy. Two patients who had dysphagia became asymptomatic. Postoperative angiographies in all patients were satisfactory. The patient whose Aberrant Subclavian Artery was ligated had no ischemic symptom of the arm. At the midterm outcomes (mean follow-up length was 55.6 ± 42.2 months, ranging 10-114 months), all patients resumed normal activities without any complications. Conclusions Kommerell's diverticulum can be repaired safely with graft replacement concomitant with in situ reconstruction of the Aberrant Subclavian Artery through thoracotomy.

R Kopp - One of the best experts on this subject based on the ideXlab platform.

  • Aberrant Subclavian Artery pathologies and kommerell s diverticulum a review and analysis of published endovascular hybrid treatment options
    Journal of Endovascular Therapy, 2012
    Co-Authors: Chenzi Yang, Ming Li, Quanming Li, R Kopp
    Abstract:

    Aberrant Subclavian Artery (ASA) is one of the most common congenital vascular anomalies of the aortic arch. The incidences of Aberrant right Subclavian Artery (ARSA) and Aberrant left Subclavian Artery (ALSA) are 0.4% to 2.3% and 0.05%, respectively. Approximately 60% of ARSA patients will have a Kommerell's diverticulum at the origin of the ASA. Symptomatic or aneurysmal ASAs need to be treated. Historically, open operation was the favored method to reconstruct ASA anatomy; however, novel endovascular techniques are now available. Following a brief discussion of embryonic development, symptoms, and treatment history of the ASA and Kommerell's diverticulum, the results of a literature review to collect the worldwide experience of endovascular/hybrid treatment of ASA is presented.

  • surgical and endovascular treatment of symptomatic Aberrant right Subclavian Artery arteria lusoria
    Vascular, 2007
    Co-Authors: R Kopp, Ingrid Wizgall, Eckart Kreuzer, G Meimarakis, R Weidenhagen, A Kuhnl, Claudius Conrad, Karlwalter Jauch, L Lauterjung
    Abstract:

    Right Aberrant Subclavian Artery, also called arteria lusoria, is one of the most common intrathoracic arterial anomalies. Although mostly asymptomatic, the retroesophageal and retrotracheal course of the lusorian Artery might result in unspecific thoracic pain, dysphagia, dyspnea, arterioesophageal or arteriotracheal fistulae with hematemesis or hemoptysis, and aneurysmal formation with relevant risk of rupture. The purpose was to present our experience with six patients with a symptomatic Aberrant right Subclavian Artery, two patients with dysphagia or dyspnea caused by a nonaneurysmal lusorian Artery, and four patients with arteria lusoria aneurysms. The operative procedures performed are described and discussed in view of the data reported in the literature. According to the classification of the lusorian Artery pathology, a combined intervention with right Subclavian Artery transposition, distal or proximal lusorian Artery ligation or proximal endovascular occlusion for nonaneurysmal disease, or endovascular thoracic aortic stent graft implantation for lusorian Artery aneurysms seems to be an additional and minimally invasive approach with promising midterm results.

  • surgical and endovascular treatment of symptomatic Aberrant right Subclavian Artery arteria lusoria
    Vascular, 2007
    Co-Authors: R Kopp, Ingrid Wizgall, Eckart Kreuzer, G Meimarakis, R Weidenhagen, A Kuhnl, Claudius Conrad, Karlwalter Jauch, L Lauterjung
    Abstract:

    Right Aberrant Subclavian Artery, also called arteria lusoria, is one of the most common intrathoracic arterial anomalies. Although mostly asymptomatic, the retroesophageal and retrotracheal course...

Akihiro Miya - One of the best experts on this subject based on the ideXlab platform.

  • Right-sided aortic arch and Aberrant left Subclavian Artery with or without a left nonrecurrent inferior laryngeal nerve
    Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2016
    Co-Authors: Hiroo Masuoka, Tomonori Yabuta, Akira Miyauchi, Minoru Kihara, Takuya Higashiyama, Akihiro Miya
    Abstract:

    Background In thyroid surgery, preserving the recurrent laryngeal nerve (RLN) is crucial for preventing postoperative phonatory dysfunction. Right nonrecurrent laryngeal nerves (NRLNs) are not particularly rare, and they are vulnerable to injury during surgery. This anomaly is associated with a right Aberrant Subclavian Artery. Thus, a right-sided aortic arch with an Aberrant left Subclavian Artery (LSA) suggests a possible left NRLN. Methods We report the cases of 4 patients with right-sided aortic arch and Aberrant LSA. Preoperative imaging studies revealed those anomalies, but no signs of situs inversus. During the surgeries, only 1 of the 4 cases had a left NRLN. We retrospectively evaluated the patients' imaging studies. Results An aortic diverticulum was found at the point at which the Aberrant LSA originated in the 3 patients with left-RLNs, but not in the patient with the left-NRLN. Conclusion In right-sided aortic arch + Aberrant LSA cases, the absence of an aortic diverticulum suggests a left NRLN. © 2016 The Authors Head & Neck Published by Wiley Periodicals, Inc. Head Neck, 2016

Michael J Jacobs - One of the best experts on this subject based on the ideXlab platform.

  • treatment of symptomatic Aberrant Subclavian arteries
    European Journal of Vascular and Endovascular Surgery, 2014
    Co-Authors: Houman Jalaie, Jochen Grommes, Anna M Sailer, Andreas Greiner, Marcel Binnebosel, Johannes Kalder, Geert Willem H Schurink, Michael J Jacobs
    Abstract:

    Objective The aim of this study is to present experience with 10 patients with symptomatic Aberrant Subclavian Artery (ASA) and aneurysm of ASA who underwent surgical treatment. Methods From 2008 to 2011 10 patients with symptomatic Aberrant Subclavian Artery (mean age 60 years [range 24–90 years]) were studied. Symptoms were dysphagia ( n  = 7), dyspnea ( n  = 4), acute chest pain ( n  = 1), respiratory distress syndrome ( n  = 1), superior cava syndrome, and shock ( n  = 1). Six patients had aneurysm formation of the ASA (mean diameter of 7.1 cm [range 3.0–12.4 cm]; rupture [ n  = 1], dissection [ n  = 1]). All data were analyzed retrospectively. Results Treatment was performed as a hybrid procedure in eight patients. This included thoracic endoluminal graft exclusion with revascularization of the ASA, a pure endovascular procedure with two occluders in one patient, and an open procedure in one patient with ligation of the Aberrant Artery through a thoracotomy. Three patients died during the early postoperative period owing to pulmonary complications. All three suffered from a symptomatic aneurysm, and two were treated as an emergency procedure. Median follow-up was 20 months (range 12–49 months). Conclusion A symptomatic ASA and its associated aneurysmal formation should be excluded after diagnosis. In most cases, a hybrid procedure consisting of thoracic endografting and revascularization of the ASA is feasible.

Duarte Machado - One of the best experts on this subject based on the ideXlab platform.

  • a common symptom in two uncommon coexistent conditions glomus jugulare tumor and dysphagia lusoria
    Clinical Neurology and Neurosurgery, 2012
    Co-Authors: Shivam Om Mittal, Bahman Jabbari, Duarte Machado
    Abstract:

    Glomus jugulare (GJ) tumors are paragangliomas originating rom chromaffin cells. GJ tumors are very rare with an estimated ncidence around one per 1.3 million people [1]. These neoplasms re highly vascularized and histologically benign in most cases but ay invade bone, blood vessels, dura mater, and cranial nerves. atients with GJ tumor usually present with conductive hearing oss and pulsatile tinnitus. Growth of the tumor can cause facial erve (FN) paralysis, vertigo, hoarseness, and paralysis of lower ranial nerves [2]. Active GJ tumors secrete catecholamine into the irculation presenting with vasomotor symptoms like headaches, xcess lacrimation, diarrhea and episodic flushing [3]. Dysphagia is n uncommon presentation of glomus jugulare tumor (6%) [1]. Dyshagia lusoria due to compression of the esophagus by an Aberrant ubclavian Artery is also uncommon with a prevalence of 0.5–1.8% 4]. We present a rare catecholamine secreting GJ tumor which coxisted with an Aberrant Subclavian Artery. Although dysphagia was nitially attributed to the Aberrant Subclavian Artery, later work up ndicated a GJ tumor as the main culprit. To our knowledge, coxistence of GJ tumor and Aberrant Subclavian Artery has not been eported before in the literature. Moreover active catecholamine

  • dysphagia the common thread in two uncommon coexistent conditions glomus jugulare tumor and dysphagia lusoria p03 146
    Neurology, 2012
    Co-Authors: Shivam Om Mittal, Bahman Jabbari, Duarte Machado
    Abstract:

    Objective: To report a case of glomus jugulare tumor that was initially diagnosed as dysphagia lusoria. Background Glomus jugulare (GJ) tumors are very rare with an estimated incidence around one per 1.3 million people. Patients with GJ tumor usually present with conductive hearing loss and pulsatile tinnitus. Growth of the tumor can cause facial nerve paralysis, vertigo, hoarseness, and paralysis of lower cranial nerves. Active GJ tumors secrete catecholamines into the circulation. Patients with active GJ tumors have vasomotor symptoms like headaches, excess lacrimation and episodic flushing. Dysphagia is an uncommon presentation of GJ tumor (6%). Dysphagia lusoria due to compression of the esophagus by an Aberrant Subclavian Artery is also uncommon with a prevalence of 0.5- 1.8%. Design/Methods: This is a case report from Yale-New Haven Hospital. Results: A 46-year-old female presented with progressive dysphagia with headaches and unilateral cranial nerve palsies demonstrating facial droop, tongue deviation and weakness of neck and shoulder muscles. Initial work up for her dysphagia revealed an Aberrant right Subclavian Artery compressing the esophagus, so her symptoms were thought to be secondary to dysphagia lusoria. However, there was no relief of her dysphagia after the corrective surgery, and her headaches persisted. MRI of the brain was then done and revealed a GJ tumor. Octreotide scan depicted an octreotide-avid mass at the left jugular foramen consistent with a paraganglioma. Catecholamine assessments showed increased levels of epinephrine and normetanephrine in a 24 hour urine study. She underwent radiosurgical treatment with 16 Gy in a single fraction with improvement in her dysphagia. Conclusions: This case illustrates an unusual presentation of a rare catecholamine secreting GJ tumor (active type) causing dysphagia which initially mimicked dysphagia lusoria. This highlights the need to be vigilant in keeping a broad differential diagnosis in patients presenting with dysphagia. Disclosure: Dr. Mittal has nothing to disclose. Dr. Jabbari has nothing to disclose. Dr. Machado has nothing to disclose.