Combined surgery for the treatment of bilateral subclavian artery aneurysm in Marfan syndrome

Abstract

Large bilateral aneurysm of the subclavian artery is an infrequent entity that can progress to thrombosis, embolization, or rupture if left untreated. Treatment consists of exclusion of the aneurysm by an endovascular procedure or open surgery. We present a case of large bilateral subclavian artery aneurysm in a patient with Marfan syndrome that was treated by a combination of endovascular and conventional surgery. This therapeutic approach provided good results for patency with lower morbidity and mortality.

Surgical approach to left subclavian artery aneurysm in Marfan syndrome

“…They thought that they provided the possibility for less aggressive treatment with lower morbidity and mortality and good outcome with respect to patency. 3,10,11 In the present case, although stent-grafts need a proximal and distal landing zone, 11 it seemed from preoperative CT that both sides of the aneurysm were not suffi ciently straight. Moreover, in the case of a connective disorder such as Marfan syndrome, dilatation of the stent graft landing zone could develop to a type 1 endoleak.…”

“…Moreover, in the case of a connective disorder such as Marfan syndrome, dilatation of the stent graft landing zone could develop to a type 1 endoleak. 10 Therefore, open surgery was considered the optimal course in our case. We successfully treated the SAA without any complications.…”

Hybrid Repair of Bilateral Subclavian Artery Aneurysms in a Patient with Marfan Syndrome

“…8 Only case reports of subclavian artery aneurysms related to Marfan syndrome exist in the literature [4][5][6]9,10 Patients can present with ischemic complications related to thrombosis or embolization. Rupture is rare, being seen in only two of 31 patients in the series of Pairolero et al 8 Compression-related symptoms can include upper extremity motor and sensory deficits, respiratory distress, hoarseness, Horner syndrome, and dysphagia.…”

“…4,6,13 This technology is even more attractive in patients with connective tissue disorders as it can diminish the need for arterial anastomoses and help avoid reoperative surgery. 5 Although endovascular repair has become common, long-term data regarding durability, patency, and maintenance of structure and position in a mobile area are absent. Patients will need more frequent postprocedure imaging studies to ensure adequacy of the repair.…”

“…4 Several reports have demonstrated successful endovascular treatment of subclavian artery aneurysms in Marfan patients. 5,6 We present the hybrid repair of bilateral subclavian artery aneurysms in a patient with Marfan syndrome.…”