Hybrid Repair of Proximal Subclavian Artery Aneurysm

Abstract

Objective: Conventional open repair for proximal subclavian artery aneurysms (SCAAs) requires cardiopulmonary bypass. However, patients with proximal SCAA can be treated with hybrid repair. Methods: Between 2007 and 2012, we performed hybrid repair to treat six consecutive patients with proximal SCAA (three left SCAAs, one right aberrant SCAA, two right SCAAs). Their median age was 73.5 [70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][86][87] years, and the size of their aneurysm was 33.5 [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] mm. Thoracic endovascular aneurysm repair (TEVAR) only was used for one patient with left SCAA, TEVAR and supra-aortic bypass for two with left SCAA and one with right aberrant SCAA, and endovascular repair with reconstruction of the vertebral artery using the saphenous vein graft (SVG) for two with right SCAA. Results: The follow-up duration was 3.7 [0.2-6.8] years. There was no 30-day mortality and only one early complication consisting of a minor stroke after TEVAR for shaggy aorta. Two late deaths occurred, one caused by cerebral infarction due to occlusion of SVG to the dominant vertebral artery 2 months after the operation and the other by aortic dissection 5 years postoperatively. Conclusions: Hybrid repair can be a less-invasive alternative for proximal SCAA. Revascularization of neck vessels and TEVAR should be performed very carefully to prevent neurologic complications.

Endovascular Repair of Incidentally Found Subclavian Artery Aneurysm: A Case Report From an Urban Level 1 Trauma Center

“…2 While open repair has excellent long-term outcomes, 8 recent trends in management are moving toward endovascular repair. 1 -3,5 -7,9 -13 We describe a case of incidentally discovered large proximal saccular subclavian aneurysm with suspected remote traumatic etiology with a successful endovascular repair.…”

“…The typical location of SAA is an intrathoracic proximal segment of the subclavian artery. 1,5 Locations other than the intrathoracic proximal subclavian artery are usually secondary to connective tissue disorders. 5 Other causes include traumatic pseudoaneurysms and iatrogenic injury from inadvertent cannulation.…”

“…1,5 Locations other than the intrathoracic proximal subclavian artery are usually secondary to connective tissue disorders. 5 Other causes include traumatic pseudoaneurysms and iatrogenic injury from inadvertent cannulation. 6,7 The SAAs can lead to life-threatening complications such as rupture, thrombosis, and embolism.…”

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

“…The majority (39%) of subclavian artery aneurysms are in the proximal segment, and the middle and distal segments make up for the rest . Atherosclerosis is the main underlying cause when it comes to intrathoracic aneurysms, whereas those arising from the extrathoracic segments are often related to previous trauma (iatrogenic), thoracic outlet syndrome, and connective tissue disorders . Other less frequent causes include large vessel vasculitis, cystic medial necrosis, mycotic processes, syphilis, and tuberculosis .…”

Open Surgical Approach for Type II Endoleak in Subclavian Artery Pseudoaneurysm Presented With Neurological Symptoms After Endovascular Repair

“…These aneurysms are classified into intrathoracic and extrathoracic, with the most common location being the intrathoracic proximal segment of the subclavian artery. 1,2 These aneurysms are asymptomatic in 70% of patients; however, those who are symptomatic often experience pain and compressive or ischemic symptoms. Herein, we present a case of a traumatic subclavian artery pseudoaneurysm presenting with brachial plexus compression.…”