Long-term outcomes of endovascular treatment of isolated subclavian artery aneurysms

Abstract

Objectives The aim of the present study was to review our institutional experience of endovascular treatment for isolated subclavian artery aneurysms and evaluate the long-term outcomes. Methods A retrospective review of all patients with isolated subclavian artery aneurysms who underwent endovascular treatment between March 2008 and March 2020 was performed. The demographics, aneurysmal characteristics, treatment strategies, and in-hospital and follow-up outcomes were recorded and then analyzed. Results From March 2008 to March 2020, 35 isolated subclavian artery aneurysms were endovascularly treated at our institution. Atherosclerosis was the most common cause of aneurysms in this series. Most aneurysms were intrathoracic (91.4%) and located at the right side (77.1%). There were 26 true aneurysms, seven pseudoaneurysms, and two ruptured isolated subclavian artery aneurysms. Five types of endovascular strategies were performed. Covered stent placement across the aneurysm was the most (54.3%) commonly used method. Technical success was achieved in all patients. The median postoperative in-hospital stay was 4.0 days (range, 1–15 days). One patient died after discharge but within 30 days of surgery due to myocardial infarction. The median follow-up time was 62.0 months (range, 3–132 months). No death, stroke, stent fractures, or severe upper limb ischemia developed during the follow-up period. The cumulative survival rate at five years was 97.1%. The overall complication rate was 25.7% and one-third of complications (8.6%) required reinterventions. Conclusions Endovascular treatment for isolated subclavian artery aneurysms is safe, effective and technically achievable in most patients. Short- and long-term outcomes are promising. Reasonable and flexible use of covered stents can also get satisfactory outcomes in some complicated lesions such as isolated subclavian artery aneurysms located at the origin of the right subclavian artery, avoiding the huge surgical trauma caused by conventional open repair.

Open repair of transverse cervical pseudoaneurysm

“…The need for manipulation of peri-clavicular anatomy may injure the brachial plexus and adjacent vessels, contributing to morbidity and mortality with open surgical repair [ 11 ]. Other options include endovascular treatment [ 3 , 12 ], but long-term outcomes of this approach in subclavian artery pseudoaneurysms are limited [ 13 ]. Guidelines for treatment of subclavian artery pseudoaneurysms and branch pseudoaneurysms have not been established, but both open and endovascular approachs may be adopted dependent on their location and configuration [ 9 , 13 ].…”

“…Other options include endovascular treatment [ 3 , 12 ], but long-term outcomes of this approach in subclavian artery pseudoaneurysms are limited [ 13 ]. Guidelines for treatment of subclavian artery pseudoaneurysms and branch pseudoaneurysms have not been established, but both open and endovascular approachs may be adopted dependent on their location and configuration [ 9 , 13 ]. Regardless of approach, all anyeursms must be treated irrespective of size.…”

Coil embolization with open frozen hybrid graft for complex left subclavian artery/proximal descending aortic aneurysm in a young patient

“…The development of percutaneous techniques led to the application of endovascular procedures for the treatment of SCA. Anderson and Fang reported excellent outcomes of endovascular procedures for the treatment of SCA in series of respectively 19 and 35 patients 3,4 . At a 24‐ and 62‐month follow‐up period, 3% and 8.6% of patients required reoperations for endoleaks, stent, or bypass graft occlusion or infection 3,4 .…”

“…3,4 At a 24-and 62-month follow-up period, 3% and 8.6% of patients required reoperations for endoleaks, stent, or bypass graft occlusion or infection. 3,4 Long-term results of endovascular repair still remain undefined.…”

“…Anderson and Fang reported excellent outcomes of endovascular procedures for the treatment of SCA in series of respectively 19 and 35 patients. 3,4 At a 24-and 62-month follow-up period, 3% and 8.6% of patients required reoperations for endoleaks, stent, or bypass graft occlusion or infection. 3,4 Long-term results of endovascular repair still remain undefined.…”