Mycotic right subclavian artery aneurysm: a rare and challenging pathology

Abstract

Mycotic subclavian artery aneurysms are rare but challenging pathology. We report a 67-year-old woman who presented with recurrent bacteremia secondary to chronic clavicular osteomyelitis. Imaging demonstrated a right subclavian artery aneurysm near the innominate artery bifurcation and in close proximity to the infected clavicle. Owing to the anatomic location, among other factors, she underwent open repair using a rifampin-soaked Dacron conduit. Analysis of the aneurysm wall identified bacteria consistent with intraoperative bone and blood cultures. Contributions from multiple surgical and medical specialties provided a favorable, long-term outcome for the patient.

Open repair of a proximal left subclavian artery mycotic aneurysm with median claviculectomy

“… 7 , 10 As such, all SAMAs must be treated in a timely manner to prevent further complications such as hemorrhage, worsening septicemia, and arteriovenous fistula creation. 1 Broad-spectrum intravenous antibiotics, followed by specific antibiotics based on cultures, should also be initiated and maintained for a minimum of 6 weeks, depending on the mycotic aneurysm characteristics and type of repair. 1 To this day, open surgical treatment remains the gold standard as the most conventional repair modality for SAMAs.…”

“… 1 Broad-spectrum intravenous antibiotics, followed by specific antibiotics based on cultures, should also be initiated and maintained for a minimum of 6 weeks, depending on the mycotic aneurysm characteristics and type of repair. 1 To this day, open surgical treatment remains the gold standard as the most conventional repair modality for SAMAs. 1 , 7 Because of the infectious nature of SAMAs, excision of all infected tissue is imperative in preventing reinfection and ensuring better postoperative outcomes for these patients.…”

“…Subclavian artery mycotic aneurysms (SAMAs) are extremely rare, accounting for <5% of the total subclavian artery aneurysms in the past 30 years. 1 , 2 Although patients are often poor surgical candidates, more invasive methods of exposure such as thoracotomy or median sternotomy are still used in the treatment of SAMAs. 2 , 3 , 4 , 5 , 6 An anatomic exposure using claviculectomy has remained underused and rather controversial.…”

Carotid-Axillary Bypass and Debridement for a Mycotic Aneurysm of the Left Subclavian Artery

“…Mycotic aneurysms of the subclavian artery are extremely rare and have only accounted for less than 5% of all documented subclavian aneurysms over the past 3 decades. 6 They are often technically challenging to treat, and the open repairs, especially in poor surgical candidates, can be associated with significant morbidity and mortality. This case was particularly unique in several ways; the first being that no obvious inciting cause of the retrosternal abscess was found.…”

“…Similar patency rates for autologous and antibiotic-soaked prosthetic grafts have also been reported. 6 Cryo-preserved allografts have also been used successfully in the absence of suitable autologous veins or prosthetic grafts. 7 The endovascular technique for repair has been described in some series either as a sole treatment strategy or as a bridge to open repair in high risk surgical patients or in patients presenting with ruptured aneurysms.…”