Endovascular treatment of the subclavian artery aneurysm in high-risk patient - a single-center experience

Abstract

We present our first experience with endovascular treatment of 6 subclavian artery aneurysms (SAA) occurring in five male and one female patient. All patients, in our studies, according to ASA classification were high risk for open repair of SAA. The etiology of the all aneurysms was atherosclerosis degeneration of the artery. Two aneurysms were of intrathoracic location, then the other were extrathoracic. Symptoms related to subclavian artery aneurysms were present in two patients, compression and chest pain in one, and hemorrhage shock in second, while the remaining patients were asymptomatic. We preferred the Viabhan endoprosthesis for endovascular repair in 5 cases. In one patient with ruptured of subclavian artery aneurysm who was high-risk for open repair we made combined endovascular procedure. First at all, we covered the origin of left subclavian artery with thoracic stent graft and after that we put two coils in proximal part of subclavian artery. There was no operative mortality, and the early patency rate was 100%. The follow-up period was from 3 months to 3 years. During this period, one patient died of heart failure and one patient required endovascular reoperation due to endoleak type I. Endovascular treatment is recommended for all patients with subclavian artery aneurysm whenever this is possible due to anatomical reasons especially in high-risk patient with intrathoracic localization of aneurysm, to prevent potential complications.

A case report of a ruptured subclavian artery aneurysm presenting to the emergency department

“…Repair has historically been via open surgical procedure using median sternotomy or lateral thoracotomy, but this is associated with higher rates of postoperative complications. Endovascular repair, as in our patient's case, is more desirable for patients deemed unfit for surgery …”

“…Subclavian artery aneurysms (SAA) are extremely uncommon and represent 0.1% of all aortic aneurysms . They are, however, associated with serious life‐threatening complications such as rupture, thrombosis, embolization, and compression of surrounding structures . They can either be intrathoracic or extrathoracic, with the former being caused largely by underlying atherosclerosis .…”

“…Open repair via median sternotomy has traditionally been the mainstay approach, but there has recently been increasing reports of successful endovascular interventions. These offer a minimally invasive alternative in high‐risk patients …”

Extrathoracic subclavian artery aneurysm in a patient with suspected genetic arteriopathy

“…13,14 As such, we recommend endovascular stent grafts (such as Viabhan endoprosthesis) for patients who are high-risk surgical candidates or in circumstances of rupture in which the stent grafts provide rapid control of hemorrhage. 15 In rare circumstances of mycotic SCAA, coil embolization maybe appropriate. 16 Our case demonstrates the importance of genetic testing to establish the diagnosis.…”

Claviculectomy for exposure and redo repair of expanding, recurrent right subclavian aneurysm

“…Open, endovascular, and hybrid approaches to treat SAA have similar reported morbidity and mortality rates 1,3,12,13 . In one review of 381 SAA repairs, overall complication rates were 27% for open repair, 25% for endovascular repair, and 20% for hybrid repair.…”