Hybrid management of proximal right subclavian artery aneurysms

Abstract

Surgical repair of proximal right subclavian artery aneurysms can be difficult. They typically require a combined mediastinal exposure to control the innominate and right common carotid arteries and a supra- or infraclavicular exposure for distal control, with either a segmental resection and bypass or a bifurcated reconstruction. In this report, we present four cases utilizing a single-stage, hybrid technique combining an endovascular stent graft and an extra-anatomical bypass to repair proximal right subclavian artery aneurysms without the need for mediastinal exposure or extensive surgical reconstruction. There were no deaths and two minor neurologic events.

Results of aberrant right subclavian artery aneurysm repair

“…[20][21][22][23][24][25] In a recent systematic review collecting overall 31 endovascular or hybrid published cases for aneurysms on aberrant subclavian arteries, Yang et al 1 found that the hybrid approach, including thoracic stent grafting with distal subclavian ligation, was the most frequently used.…”

A Case of Subclavian Artery Injury Due to Blunt Trauma Treated Successfully by Endovascular Repair

“…Stent insertion alone is sometimes inadequate to treat the injury, and combinations of stenting with coils 15) , open surgery 16) or balloon occlusion 14) have been reported. One limitation of endovascular treatment in this case was that although the membrane of the covered stent was made using ePTFE, which is commonly used for artificial blood vessels, long-term patency has not been confirmed.…”

“…Aspirin and clopidogrel were administered as antiplatelet therapy. Computed tomography on day 16 showed that the stent graft was in a suitable position, and the aneurysm had disappeared (Fig. 5 ).…”

Utility of Preoperative 3D CT Angiography and Proximal Balloon Occlusion to Minimize Morbidity of Open Repair of a True Subclavian Artery Aneurysm

“…The approach to both open and endovascular SAA repair depends greatly on the anatomic location and involvement of the cerebrovascular circulation [8]. Anticipation of posterior circulation adequacy post-intervention is paramount to good outcomes and may have direct implications on the revascularization strategy employed [8,9]. Because of the dominance of the contra lateral vertebral artery, this patient's right vertebral was ligated without revascularization.…”

“…Open repair for aneurysms with intra-thoracic involvement frequently requires sternotomy or lateral thoracotomy [3], and hybrid techniques can often decrease the extent of exposure required for repair 9 . Although excellent long-term patency of direct arterial reconstruction of subclavian aneurysms has been reported, the resultant peri-operative morbidity can be prohibitive for selected patients [12].…”