Basic data underlying clinical decisionmaking in vascular surgery Section Editor ~ John M. Porter, MD (Portland, Oregon)
Basic Data Related to Peripheral Artery Aneurysms Richard L. McCann, MD Durham, North Carolina
Peripheral artery aneurysms obviously encompass a broad anatomic range. The following tables present basic data selected to define the clinical characteristics of each lesion. For both femoral and popliteal aneurysms there is a marked male predominance, with lesions in females being distinctly unusual. A majority of patients with these lesions have a generalized tendency toward aneurysm formation and many harbor aneurysms at multiple sites. Over one-third will have abdominal aortic aneurysms. Popliteal aneurysms seldom rupture but often cause ischemic symptoms by thrombosis or embolism. Carotid aneurysms occur in younger patients with only about a 2:1 male-female ratio. Only about one-half of the lesions appear to be caused by atherosclerosis with the remainder divided between false aneurysms, surgical trauma, and connective tissue diseases. While
From the Department of Surgery, Duke University Medical Center, Durham, North Carolina. Reprint requests: Richard L. McCann, MD, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710.
occasionally subject to rupture, carotid aneurysms are much more likely to cause thromboembolic stroke, and prevention of this complication is the most pressing indication for surgery. Subclavian aneurysms are unusual and also occur in younger patients. They are more common on the right, and approximately half result from atherosclerosis. For unknown reasons, aberrant subclavian arteries are particularly prone to aneurysm development. About half of subclavian aneurysms will require a transthoracic procedure. Another interesting and unusual lesion is the persistent sciatic artery. While the incidence of this vascular anomaly is rare, the aberrant vessel has an unusual tendency to become aneurysmal. Because of general degeneration of the vascular tree in these cases, there is a high amputation rate. Although Takayasu's disease is most firmly associated with obstructive lesions, a percentage of patients with this condition will develop dilated and even aneurysmal arterial segments. Femoral false aneurysms are common, especially if methodically sought by routine ultrasound or arteriography. Interestingly, most are associated with proximal inflow reconstructions rather than outflow procedures. Recurrence of femoral false aneurysms appears more common after repair by direct suture compared to repair by placement of an interposition graft.
411
412
ANNALS OF VASCULAR SURGERY
PERIPHERAL ARTERY ANEUR YSMS
TABLE I.--Clinical data related to atherosclerotic femoral artery aneurysms
TABLE II.--Clinical data related to popliteal aneurysms
References Mean age at presentation Sex (male:female) Percent bilateral Percent with AAA* Risk to limb without repair of small asymptomatic FAAt Ratio of risk of rupture to thromboembolic complications
65 years 28:1 54% 75%
1-3 1-3 1-3 1-3
5%
3
2:13
3
Sex (male:female) Mean age at presentation Percent asymptomatic Percent bilateral Percent with other aneurysm Percent with AAA*
33:1 63 years 39% 56% 50% 33%
References 4-10 4-5, 7-9 4-10 4-10 4-10 4-10
* A A A = abdominal aortic aneurysm
* A A A = abdominal aortic a n e u r y s m I F A A = femoral artery aneurysm
TABLE IV.--Clinical data related to carotid artery aneurysms TABLE III.--Results of treatment of popliteal aneurysms Saphenous vein graft failure rate Synthetic graft failure rate Limb salvage if patient asymptomatic Limb salvage if patient symptomatic
References 4-10
12% 55%
5-10
98%
5-10
81%
5-10
Sex (male:female) Mean age at presentation Percent with neurologic symptoms Percent with mass
2:1 56 years
References 11-21, 23 13-15, 18-20
40%
11-23
56%
11-23
TABLE VI.--Outcome in patients with carotid artery aneurysm
TABLE V.--Etiology of carotid artery aneurysms Atherosclerosis Trauma Pseudoaneurysm (postendarterectomy) Other (syphilis, connective tissue disease, etc.)
53% 13% 21%
References 11-23 11, 13-19, 23 13-17, 21-23
12%
13, t7-18, 21-23
Stroke rate (%) 18
Mortality rate (%) 5
Carotid ligation
25
20
Carotid reconstruction
8
2
Unoperated
References 13, 17, 1921, 23 12-14, 17, 18, 21,23 11-14, 1622
TABLE VIIl.--Clinical data related to aneurysm in aberrant subclavian artery
TABLE VII.--Clinical data related to subclavian artery aneurysms Male :female Mean age at presentation Right:left Atherosclerotic etiology Transthoracic operation
2:1 49 years 2:1 46% 43%
References 24-27 24-27 24-27 24-27 24-27
Male:female Incidence of aberrant subclavian artery Atherosclerotic etiology of aneurysm Dysphagia lusoria Chest mass on x-ray Left aortic arch, aberrant right subclavian artery Concurrent abdominal aortic aneurysm Percent ruptured
2.5:1 0.5%
References 28-30 28-30
90%
28-30
39% 94% 97%
28-30 28-30 28-30
25%
28-30
20%
28, 29
VOLUME 4 No 4 - 1990
PERIPHERAL ARTERY ANEURYSMS
TABLE IX.BClinicai data related to persistent sciatic artery
Incidence Left:right:bilateral Sex (male:female) Mean age at presentation Incidence of aneurysm formation Location of aneurysm Preferred treatment
Amputation rate
.025-.06% 9:8:6 5:4 65 years
References 32, 36-37 31, 35, 38 32-38 32-38
15-44%
36, 37
greater trochanter ligation or thrombosis with bypass CFA* popliteal 28%
36 36, 38
39
*CFA = Common Femoral Artery.
TABLE X.BClinical data related to aneurysms in Takayasu's disease References
Incidence of aneurysm in Takayasu's disease Relative distribution of aneurysms Carotid artery Subclavian artery Thoracic aorta Abdominal aorta
12%
40, 41
20 10 40 30
40 40 40 40
413
REFERENCES 1. PAPPAS G, JANES JM, BERNATZ PE, et al. Femoral aneurysms. Review of surgical management. JAMA 1964; 190:489--493. 2. CUTLER BS, DARLING RC. Surgical management of arteriosclerotic femoral aneurysms. Surgery 1973;74:764-773. 3. GRAHAM LM, ZELENOCK GB, WHITEHOUSE WM Jr, et al. Clinical significance of arteriosclerotic femoral artery aneurysms. Arch Surg 1980;115:502-507. 4. SCHELLACK J, SMITH RB III, PERDUE GD. Nonoperative management of selected popliteal aneurysm. Arch Surg
1987;122:372-375. 5. FARINA C, CAVALLARO A, SCHULTZ RD, et al. Popliteal aneurysms. Surg Gynecol Obstet 1989;169:7-13. 6. MANGIANTE EC, FABIAN TC, HUFFSTUTTER PJ. Poplitea[ aneurysms. A clinical appraisal. Am Surg 1984;50:469-472. 7. LILLY MP, FLINN WR, MCCARTHY WJ, et al. The effect of distal arterial anatomy on the success of popliteal aneurysm repair. J Vasc Surg 1988;7:653-660. 8. VERMILION BD, KIMMINS SA, PACE WG, et al. A review of one hundred forty-seven popliteal aneurysms with long-term follow-up. Surgery 1981 ;12:100%1014. 9. MELLIER D, VEIT R, BECQUEMIN JP, et al. Should all spontaneous popliteal aneurysms be operated on? J Cardiovasc Surg 1986;27:273-277. 10. COLE CW, THIJSSEN AM, BARBER GG, et al. Popliteal aneurysms: an index of generalized vascular disease. Canad J Surg 1989;32:65~58. 11. MOKRI B, PIEPGRAS DG, SUNDT TM Jr, et al. Subject review. Extracranial internal carotid artery aneurysms. Mayo Clin Proc 1982;57:310-321. 12. PAINTER TA, HERTZER NR, BEVEN EG. Extracranial carotid aneurysms: report of six cases and review of the literature. J Vasc Surg 1985;2:312-318. 13. BUSUTTIL RW, DAVISON RK, FOLEY KT, et al. Selective management of extracranial carotid artery aneurysms.
Am J Surg 1980;140:85-91. 14. KAUPP HA, HAID SP, JURAYJ MN, et al. Aneurysms of the external carotid artery. Surgery 1972;72:946-952. 15. EHRENFELD WK, STONEY RJ, WYLIE EJ. Relation of carotid stump pressure to safety of carotid artery ligation. Surgery 1983;93:29%305. 16. RITTENHOUSE EA, RADKE HM, SUMNER DS. Carotid artery aneurysm. Review of the literature and report of a case with rupture into the oropharynx. Arch Surg 1972;105:786-- 789. 17. RHODES EL, STANLEY JC, HOFFMAN GL, et al. Aneurysm of extracranial carotid arteries. Arch Surg 1976;
111:33%343.
TABLE Xl.--Clinical data related to femoral false aneurysms References
Clinical incidence per femoral anastomosis Incidence detected by digital subtraction arteriography Sex (male:female) Original procedure for aneurysm Original procedure for obstruction Percent due to aortoiliac reconstructions Percent due to fem-pop reconstructions Recurrence after repair by suture Recurrence after repair by interposition graft
4%
42, 44, 46
44% 8.5:1
46 42-43, 45
41%
42-44
59%
42-45
92%
42-43, 45
8%
42-43, 45
27%
42-43, 45
7%
42-43, 45
18. MCCOLLUM CH, WHEELER WG, NOON GP, et al. Aneurysms of the extracranial carotid artery. Twenty-one years experience. Am J Surg 1979;137:196--200. 19. ZWOLAK RM, WHITEHOUSE WM Jr, KNAKE JE, et al. Atherosclerotic extracranial carotid artery aneurysms. J Vasc Surg 1984;1:415--422. 20. DEHN TCB, TAYLOR GW. Extracranial carotid artery aneurysms. Ann Royal CoN Surg 1984;66:247-250. 21. KRUPSKI WC, EFFENEY DJ, EHRENFELD WK, et al. Aneurysms of the carotid arteries. Aust N Z J Surg 1983; 53:521-525. 22. WELLING RE, TAHA A, GOEL T, et al. Extracranial carotid artery aneurysms. Surgery 1983;2:319-323. 23. PRATSCHKE E, SCHAFER K, REIMER J, et al. Extracranial aneurysms of the carotid artery. J Thorac Cardiovasc Surg 1980;28:354-358. 24. PAIROLERO PC, WALLS JT, PAYNE WS, et al. Subclavian- axillary artery aneurysms. Surgery 1981;90:757-763. 25. MCCOLLUM CH, DA GAMA AD, NOON GP, et al. Aneurysm of the subclavian artery. J Cardiovasc Surg 1979;20:15%164. 26. HOBSON RW, SARKARIA J, O'DONNELL JA, et al.
414
27.
28.
29.
30.
31.
32. 33.
34. 35. 36. 37.
PERIPHERAL A R TER Y A N E U R YSMS
Atherosclerotic aneurysms of the subclavian artery. Surgery 1979;85:368-371. COSELLI JS, CRAWFORD ES. Surgical treatment of aneurysms of the intrathoracic segment of the subclavian artery. Chest 1987;91:704-708. AUSTIN EH, WOLFE WG. Aneurysm of aberrant subclavian artery with a review of the literature. J Vasc Surg 1985;2:571-577. ESPOSITO RA, KHALIL I, SPENCER FC. Surgical treatment for aneurysm of aberrant subclavian artery based on a case report and a review of the literature. J Thorac Cardiovasc Surg 1988;95:888-891. RODGERS B, TALBER J, HOLLENBECK J. Aneurysm of anomalous subclavian artery: an unusual cause ofdysphagia lusoria in childhood. Ann Surg 1978;187:158-161. FREEMAN MP, TISNADO J, CHO S-R. Persistent sciatic artery. Report of three cases and literature review. Br J Radio/ 1986;59:217-223. GREEBE J. Congenital anomalies of the iliofemoral artery. J Cardiovasc Surg 1977;18:317-323. MANDELL VS, JAQUES PF, DELANY DJ, et al. Persistent sciatic artery: clinical, embryologic, and angiographic features. A JR 1985;144:245-249. LOH FK. Embolization of a sciatic artery aneurysm. An alternative to surgery: a case report. Angio/ogy--J Vasc Dis 1985; 7: 472-476. GERNER T, HENJUM A, DEDICHTEN H. Persistent sciatic artery. Case report. Acta Chir Scand 1988;154:667--668. MAYSCHAK DT, FLYE MW. Treatment of the persistent sciatic artery. Ann Surg 1984;199:69-74. WILLIAMS LR, FLANIGAN DP, O'CONNOR RJA, et al.
mmm
38.
39. 40.
41. 42.
43. 44. 45.
46.
ANNALS OF
VASCULAR SURGERY
Persistent sciatic artery. Clinical aspects and operative management. A m J Surg 1983;145:687-693. BECQUEMIN JP, GASTON A, COUBRET P, et al. Aneurysm of persistent sciatic artery: report of a case treated by endovascular occlusion and femoropopliteal bypass. Surgery 1985;98:605-611. MARTIN KW, HYDE GL, MCCREADY RA, et al. Sciatic artery aneurysms: report of three cases and review of the literature. J Vasc Surg 1986;4:365-371. SEKO Y, YAZAKI Y, UCHIMURA H, et al. A case of Takayasu's disease with ruptured carotid aneurysm. Jpn Heart J 1986;27:523-531. LANDE A, LA PORTA A. Takayasu arteritis. An arteriographic-pathological correlation. Arch Pathol Lab Med 1976;100:437-440. DIMARZO L, STRANDNESS EL, SCHULTZ RD, et al. Reoperation for femoral anastomotic false aneurysm. A 15 year experience. Ann Surg 1987;206:168-172. SCHELLACK J, SALAM A, ABOUZEID MA, et at. Femoral anastomotic aneurysms: a continuing change. J Vasc Surg 1987;6:308-317. ERNST CB, ELLIOTT JP, RYAN CJ, et al. Recurrent femoral anastomotic aneurysm. A 30-year experience. Ann Surg 1988;208:401-409. DENNIS JW, LITTOOY FN, GREISLER HP, et al. Anastomotic pseudoaneurysm. A continuing late complication of vascular reconstructive procedures. Arch Surg 1986;121: 314-317. SIESWERDA C, SKOTNICKI SH, BARENTSZ JO, et al. Anastomotic aneurysms--an underdiagnosed complication after aorto-iliac reconstructions. Eur J Vasc Surg 1989;3:233-238.
Basic Data Related to Peripheral Artery Aneurysms Richard L. McCann, MD Durham, North Carolina
Peripheral artery aneurysms obviously encompass a broad anatomic range. The following tables present basic data selected to define the clinical characteristics of each lesion. For both femoral and popliteal aneurysms there is a marked male predominance, with lesions in females being distinctly unusual. A majority of patients with these lesions have a generalized tendency toward aneurysm formation and many harbor aneurysms at multiple sites. Over one-third will have abdominal aortic aneurysms. Popliteal aneurysms seldom rupture but often cause ischemic symptoms by thrombosis or embolism. Carotid aneurysms occur in younger patients with only about a 2:1 male-female ratio. Only about one-half of the lesions appear to be caused by atherosclerosis with the remainder divided between false aneurysms, surgical trauma, and connective tissue diseases. While
From the Department of Surgery, Duke University Medical Center, Durham, North Carolina. Reprint requests: Richard L. McCann, MD, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710.
occasionally subject to rupture, carotid aneurysms are much more likely to cause thromboembolic stroke, and prevention of this complication is the most pressing indication for surgery. Subclavian aneurysms are unusual and also occur in younger patients. They are more common on the right, and approximately half result from atherosclerosis. For unknown reasons, aberrant subclavian arteries are particularly prone to aneurysm development. About half of subclavian aneurysms will require a transthoracic procedure. Another interesting and unusual lesion is the persistent sciatic artery. While the incidence of this vascular anomaly is rare, the aberrant vessel has an unusual tendency to become aneurysmal. Because of general degeneration of the vascular tree in these cases, there is a high amputation rate. Although Takayasu's disease is most firmly associated with obstructive lesions, a percentage of patients with this condition will develop dilated and even aneurysmal arterial segments. Femoral false aneurysms are common, especially if methodically sought by routine ultrasound or arteriography. Interestingly, most are associated with proximal inflow reconstructions rather than outflow procedures. Recurrence of femoral false aneurysms appears more common after repair by direct suture compared to repair by placement of an interposition graft.
411
412
ANNALS OF VASCULAR SURGERY
PERIPHERAL ARTERY ANEUR YSMS
TABLE I.--Clinical data related to atherosclerotic femoral artery aneurysms
TABLE II.--Clinical data related to popliteal aneurysms
References Mean age at presentation Sex (male:female) Percent bilateral Percent with AAA* Risk to limb without repair of small asymptomatic FAAt Ratio of risk of rupture to thromboembolic complications
65 years 28:1 54% 75%
1-3 1-3 1-3 1-3
5%
3
2:13
3
Sex (male:female) Mean age at presentation Percent asymptomatic Percent bilateral Percent with other aneurysm Percent with AAA*
33:1 63 years 39% 56% 50% 33%
References 4-10 4-5, 7-9 4-10 4-10 4-10 4-10
* A A A = abdominal aortic aneurysm
* A A A = abdominal aortic a n e u r y s m I F A A = femoral artery aneurysm
TABLE IV.--Clinical data related to carotid artery aneurysms TABLE III.--Results of treatment of popliteal aneurysms Saphenous vein graft failure rate Synthetic graft failure rate Limb salvage if patient asymptomatic Limb salvage if patient symptomatic
References 4-10
12% 55%
5-10
98%
5-10
81%
5-10
Sex (male:female) Mean age at presentation Percent with neurologic symptoms Percent with mass
2:1 56 years
References 11-21, 23 13-15, 18-20
40%
11-23
56%
11-23
TABLE VI.--Outcome in patients with carotid artery aneurysm
TABLE V.--Etiology of carotid artery aneurysms Atherosclerosis Trauma Pseudoaneurysm (postendarterectomy) Other (syphilis, connective tissue disease, etc.)
53% 13% 21%
References 11-23 11, 13-19, 23 13-17, 21-23
12%
13, t7-18, 21-23
Stroke rate (%) 18
Mortality rate (%) 5
Carotid ligation
25
20
Carotid reconstruction
8
2
Unoperated
References 13, 17, 1921, 23 12-14, 17, 18, 21,23 11-14, 1622
TABLE VIIl.--Clinical data related to aneurysm in aberrant subclavian artery
TABLE VII.--Clinical data related to subclavian artery aneurysms Male :female Mean age at presentation Right:left Atherosclerotic etiology Transthoracic operation
2:1 49 years 2:1 46% 43%
References 24-27 24-27 24-27 24-27 24-27
Male:female Incidence of aberrant subclavian artery Atherosclerotic etiology of aneurysm Dysphagia lusoria Chest mass on x-ray Left aortic arch, aberrant right subclavian artery Concurrent abdominal aortic aneurysm Percent ruptured
2.5:1 0.5%
References 28-30 28-30
90%
28-30
39% 94% 97%
28-30 28-30 28-30
25%
28-30
20%
28, 29
VOLUME 4 No 4 - 1990
PERIPHERAL ARTERY ANEURYSMS
TABLE IX.BClinicai data related to persistent sciatic artery
Incidence Left:right:bilateral Sex (male:female) Mean age at presentation Incidence of aneurysm formation Location of aneurysm Preferred treatment
Amputation rate
.025-.06% 9:8:6 5:4 65 years
References 32, 36-37 31, 35, 38 32-38 32-38
15-44%
36, 37
greater trochanter ligation or thrombosis with bypass CFA* popliteal 28%
36 36, 38
39
*CFA = Common Femoral Artery.
TABLE X.BClinical data related to aneurysms in Takayasu's disease References
Incidence of aneurysm in Takayasu's disease Relative distribution of aneurysms Carotid artery Subclavian artery Thoracic aorta Abdominal aorta
12%
40, 41
20 10 40 30
40 40 40 40
413
REFERENCES 1. PAPPAS G, JANES JM, BERNATZ PE, et al. Femoral aneurysms. Review of surgical management. JAMA 1964; 190:489--493. 2. CUTLER BS, DARLING RC. Surgical management of arteriosclerotic femoral aneurysms. Surgery 1973;74:764-773. 3. GRAHAM LM, ZELENOCK GB, WHITEHOUSE WM Jr, et al. Clinical significance of arteriosclerotic femoral artery aneurysms. Arch Surg 1980;115:502-507. 4. SCHELLACK J, SMITH RB III, PERDUE GD. Nonoperative management of selected popliteal aneurysm. Arch Surg
1987;122:372-375. 5. FARINA C, CAVALLARO A, SCHULTZ RD, et al. Popliteal aneurysms. Surg Gynecol Obstet 1989;169:7-13. 6. MANGIANTE EC, FABIAN TC, HUFFSTUTTER PJ. Poplitea[ aneurysms. A clinical appraisal. Am Surg 1984;50:469-472. 7. LILLY MP, FLINN WR, MCCARTHY WJ, et al. The effect of distal arterial anatomy on the success of popliteal aneurysm repair. J Vasc Surg 1988;7:653-660. 8. VERMILION BD, KIMMINS SA, PACE WG, et al. A review of one hundred forty-seven popliteal aneurysms with long-term follow-up. Surgery 1981 ;12:100%1014. 9. MELLIER D, VEIT R, BECQUEMIN JP, et al. Should all spontaneous popliteal aneurysms be operated on? J Cardiovasc Surg 1986;27:273-277. 10. COLE CW, THIJSSEN AM, BARBER GG, et al. Popliteal aneurysms: an index of generalized vascular disease. Canad J Surg 1989;32:65~58. 11. MOKRI B, PIEPGRAS DG, SUNDT TM Jr, et al. Subject review. Extracranial internal carotid artery aneurysms. Mayo Clin Proc 1982;57:310-321. 12. PAINTER TA, HERTZER NR, BEVEN EG. Extracranial carotid aneurysms: report of six cases and review of the literature. J Vasc Surg 1985;2:312-318. 13. BUSUTTIL RW, DAVISON RK, FOLEY KT, et al. Selective management of extracranial carotid artery aneurysms.
Am J Surg 1980;140:85-91. 14. KAUPP HA, HAID SP, JURAYJ MN, et al. Aneurysms of the external carotid artery. Surgery 1972;72:946-952. 15. EHRENFELD WK, STONEY RJ, WYLIE EJ. Relation of carotid stump pressure to safety of carotid artery ligation. Surgery 1983;93:29%305. 16. RITTENHOUSE EA, RADKE HM, SUMNER DS. Carotid artery aneurysm. Review of the literature and report of a case with rupture into the oropharynx. Arch Surg 1972;105:786-- 789. 17. RHODES EL, STANLEY JC, HOFFMAN GL, et al. Aneurysm of extracranial carotid arteries. Arch Surg 1976;
111:33%343.
TABLE Xl.--Clinical data related to femoral false aneurysms References
Clinical incidence per femoral anastomosis Incidence detected by digital subtraction arteriography Sex (male:female) Original procedure for aneurysm Original procedure for obstruction Percent due to aortoiliac reconstructions Percent due to fem-pop reconstructions Recurrence after repair by suture Recurrence after repair by interposition graft
4%
42, 44, 46
44% 8.5:1
46 42-43, 45
41%
42-44
59%
42-45
92%
42-43, 45
8%
42-43, 45
27%
42-43, 45
7%
42-43, 45
18. MCCOLLUM CH, WHEELER WG, NOON GP, et al. Aneurysms of the extracranial carotid artery. Twenty-one years experience. Am J Surg 1979;137:196--200. 19. ZWOLAK RM, WHITEHOUSE WM Jr, KNAKE JE, et al. Atherosclerotic extracranial carotid artery aneurysms. J Vasc Surg 1984;1:415--422. 20. DEHN TCB, TAYLOR GW. Extracranial carotid artery aneurysms. Ann Royal CoN Surg 1984;66:247-250. 21. KRUPSKI WC, EFFENEY DJ, EHRENFELD WK, et al. Aneurysms of the carotid arteries. Aust N Z J Surg 1983; 53:521-525. 22. WELLING RE, TAHA A, GOEL T, et al. Extracranial carotid artery aneurysms. Surgery 1983;2:319-323. 23. PRATSCHKE E, SCHAFER K, REIMER J, et al. Extracranial aneurysms of the carotid artery. J Thorac Cardiovasc Surg 1980;28:354-358. 24. PAIROLERO PC, WALLS JT, PAYNE WS, et al. Subclavian- axillary artery aneurysms. Surgery 1981;90:757-763. 25. MCCOLLUM CH, DA GAMA AD, NOON GP, et al. Aneurysm of the subclavian artery. J Cardiovasc Surg 1979;20:15%164. 26. HOBSON RW, SARKARIA J, O'DONNELL JA, et al.
414
27.
28.
29.
30.
31.
32. 33.
34. 35. 36. 37.
PERIPHERAL A R TER Y A N E U R YSMS
Atherosclerotic aneurysms of the subclavian artery. Surgery 1979;85:368-371. COSELLI JS, CRAWFORD ES. Surgical treatment of aneurysms of the intrathoracic segment of the subclavian artery. Chest 1987;91:704-708. AUSTIN EH, WOLFE WG. Aneurysm of aberrant subclavian artery with a review of the literature. J Vasc Surg 1985;2:571-577. ESPOSITO RA, KHALIL I, SPENCER FC. Surgical treatment for aneurysm of aberrant subclavian artery based on a case report and a review of the literature. J Thorac Cardiovasc Surg 1988;95:888-891. RODGERS B, TALBER J, HOLLENBECK J. Aneurysm of anomalous subclavian artery: an unusual cause ofdysphagia lusoria in childhood. Ann Surg 1978;187:158-161. FREEMAN MP, TISNADO J, CHO S-R. Persistent sciatic artery. Report of three cases and literature review. Br J Radio/ 1986;59:217-223. GREEBE J. Congenital anomalies of the iliofemoral artery. J Cardiovasc Surg 1977;18:317-323. MANDELL VS, JAQUES PF, DELANY DJ, et al. Persistent sciatic artery: clinical, embryologic, and angiographic features. A JR 1985;144:245-249. LOH FK. Embolization of a sciatic artery aneurysm. An alternative to surgery: a case report. Angio/ogy--J Vasc Dis 1985; 7: 472-476. GERNER T, HENJUM A, DEDICHTEN H. Persistent sciatic artery. Case report. Acta Chir Scand 1988;154:667--668. MAYSCHAK DT, FLYE MW. Treatment of the persistent sciatic artery. Ann Surg 1984;199:69-74. WILLIAMS LR, FLANIGAN DP, O'CONNOR RJA, et al.
mmm
38.
39. 40.
41. 42.
43. 44. 45.
46.
ANNALS OF
VASCULAR SURGERY
Persistent sciatic artery. Clinical aspects and operative management. A m J Surg 1983;145:687-693. BECQUEMIN JP, GASTON A, COUBRET P, et al. Aneurysm of persistent sciatic artery: report of a case treated by endovascular occlusion and femoropopliteal bypass. Surgery 1985;98:605-611. MARTIN KW, HYDE GL, MCCREADY RA, et al. Sciatic artery aneurysms: report of three cases and review of the literature. J Vasc Surg 1986;4:365-371. SEKO Y, YAZAKI Y, UCHIMURA H, et al. A case of Takayasu's disease with ruptured carotid aneurysm. Jpn Heart J 1986;27:523-531. LANDE A, LA PORTA A. Takayasu arteritis. An arteriographic-pathological correlation. Arch Pathol Lab Med 1976;100:437-440. DIMARZO L, STRANDNESS EL, SCHULTZ RD, et al. Reoperation for femoral anastomotic false aneurysm. A 15 year experience. Ann Surg 1987;206:168-172. SCHELLACK J, SALAM A, ABOUZEID MA, et at. Femoral anastomotic aneurysms: a continuing change. J Vasc Surg 1987;6:308-317. ERNST CB, ELLIOTT JP, RYAN CJ, et al. Recurrent femoral anastomotic aneurysm. A 30-year experience. Ann Surg 1988;208:401-409. DENNIS JW, LITTOOY FN, GREISLER HP, et al. Anastomotic pseudoaneurysm. A continuing late complication of vascular reconstructive procedures. Arch Surg 1986;121: 314-317. SIESWERDA C, SKOTNICKI SH, BARENTSZ JO, et al. Anastomotic aneurysms--an underdiagnosed complication after aorto-iliac reconstructions. Eur J Vasc Surg 1989;3:233-238.
