Upper extremity aneurysms

Question 1

What are causes of Arch vessel aneurysms?

Answer 1

Trauma
FMD
syphilis
cystic medial necrosis
invasion by tuberculosis lymphadenitis
idiopathic

Question 2

What % of patients with arch vessel aneurysm will have aortoiliac or perish aneurysm?

Answer 2

50%

Question 3

What are most common causes of subclavian aneurysm?

Answer 3

degenerative 50%
pseudoaneurysm
TOS

Question 4

What are causes of common carotid aneurysm?

Answer 4

rare
pseudo more likely
degenerative most common if true aneurysm
FMD

Question 5

What are symptoms of UE aneurysms?

Answer 5

pain, ischemic, brachial plexus compression, hoarseness, tracheal compression, TIA, esophageal compression, hemoptysis, fistulization

Question 6

What are features on exam for UE aneurysms?

Answer 6

micro-embolization, bruit, dimished pulse, sensory/motor dysfunction, vocal cord paralysis, horner’s syndrome

Question 7

What is horners syndrome?

Answer 7

compression of sympathetic nerves
miosis, ptosis, anydrosis

Question 8

What is the innominate classification of aneurysms?

Answer 8

A distal innominate
B proximal involving origin
C proximal involving arch as well

Question 9

How does an aberrant R SCA aneurysm present?

Answer 9

dysphagia lusoria 1/3
occlusive 1/6
dyspnea/coughing from tracheal compression
chest pain from expansion

Question 10

What % of patient rupture and at what size?

Answer 10

20%
not related to size

Question 11

What is a Kommerell’s diverticulum?

Answer 11

aberrant R subclavian artery with dilated origin or diverticula
60% of aberrant R SCA

Question 12

What are the zones of the subclavian and what vessel come from each zone?

Answer 12

1st inno/arch to medial margin of ant scalene
vert, IMA, thyrocervical thrunk
2nd behind ant scalene
costocervical trunk
3rd scalene to outer border first rib
dorsal scapular artery (levator)

Question 13

What are the zones of the axillary artery?

Answer 13

First part - the part of the artery medial to pectorals minor

Second part - the part of the artery that lies posteriorly to pectorals minor

Third part - the part of the artery lateral to pectoralis minor

Question 14

What are some consideration for arch vessel endovascular repair?

Answer 14

Adequate landing zones
Branch coverage/CABG
Compression by first rib
Stroke

Question 15

What is the most common congenital abnormality of the aortic arch?

Answer 15

Aberrant right subclavian

Question 16

Where does the aberrant right subclavian usually travel?

Answer 16

Originates distal to left subclavian and usually passes posterior to and inferior to arch
Most cross midline bw esophagus and Trachea or ant to trachea

Question 17

What nerve anomaly is associated with aberrant r subclavian artery?

Answer 17

A non recurrent right laryngeal nerve

Question 18

What are treatment options for aberrant scla?

Answer 18

Non aneurysmal
Supraclavilar incision
Divide the artery
Distal end transposed to R common carotid artery

Aneurysmal
Extra anatomic bypass
Thoracotomy for excision aneurysm

Endovascular
Occluder