Left Subclavian Artery Aneurysm: Surgical Repair Via a Sternal Incision

Abstract

For trauma, the traditional approach to the proximal left subclavian artery is through a posterolateral thoracotomy. The purpose of this study was to evaluate the feasibility of accessing the proximal left subclavian artery through a partial sternotomy approach. Anatomical review of 52 subclavian arteries was performed on 52 randomly picked computed tomography (CT) scans of the thorax. The depth of the origin of the subclavian artery was measured from the lateral thoracic wall and from the sternum. It was noted that the distance from the sternum to the origin of the left subclavian artery was 4.71 cm as compared to the posterolateral wall, which was 8.87 cm. This is in contrast to the belief that the left subclavian artery is a posterior structure in the mediastinum. A subclavian artery aneurysm was repaired through the sternal approach and was noted to have an adequate exposure required for the procedure. This approach was necessitated owing to the fact that the patient had significant chronic obstructive pulmonary disease. From these data, the authors conclude that in elective circumstances it is easier and appropriate to use the partial sternotomy approach to access the proximal left subclavian artery, especially in patients who have reduced pulmonary function.

Surgical treatment of subclavian artery aneurysms

“…[3,11] Therapeutic modalities involve conservative treatment, open surgical repair, endovascular exclusion and several hybrid techniques. [3,12,13] Surgical repair by combined supra-and infraclavicular approach was mandatory. After decompression procedure of thoracic outlet syndrome (TOS), vascular reconstruction was done.…”

“…A supraclavicular access approach is usually used to reach the middle segment of the SA which may be combined with an infraclavicular incision. [3,12,14] For revascularization of the arm after exclusion of the SAA, carotid subclavian bypass was mandatory. [1][2][3] This study aimed to evaluate the surgical treatment of SAAs and its complications.…”

Changing Profiles of Diagnostic and Treatment Options in Subclavian Artery Aneurysms

“…In cases of a SAA due to TOS, aneurysm repair was often combined with first-rib resection. 71,72 Various surgical procedures have been described for the exclusion of a SAA. The first described treatment option was ligation only 11,18,20e22,35,38,42,52,55,58,68,73e76 and later in combination with a carotidesubclavian (n Z 5) 77e81 or femoro-axillary bypass (n Z 1).…”