Endovascular Treatment of a Mycotic Subclavian Artery Aneurysm Using Stent-graft

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

Surgical repair of a subclavian artery mycotic aneurysm is dependent on aneurysm-specific characteristics and anatomic exposures could require sternotomy, thoracotomy, or supraclavicular incisions. Alternatively, a median claviculectomy can be used. We successfully performed a subclavian artery to axillary artery bypass with median claviculectomy in a 23-year-old man with multiple comorbidities. Postoperative Doppler ultrasound showed a patent left axillary artery with a palpable left radial artery, and the patient demonstrated full left shoulder range of motion without any significant deformities. This case suggests that a median claviculectomy can produce satisfactory outcomes in patients with subclavian artery mycotic aneurysms.

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

Mycotic subclavian aneurysms are rare, and their presence typically mandates urgent repair due to the associated high risk of rupture and mortality. A multi-disciplinary team effort is of utmost importance in ensuring favorable results. In this case report, we present a 79-year-old male with a rapidly enlarging mycotic left subclavian artery aneurysm secondary to a retrosternal abscess and left sternoclavicular septic arthritis, who underwent aneurysmal exclusion, a left carotid-left axillary bypass and pectoralis muscle flap coverage with a good outcome.

Endovascular Repair of Three Concurrent Mycotic Pseudoaneurysms

INTRODUCTION

Mycotic pseudoaneurysm has traditionally been repaired surgically with excision of the infected artery and revascularization via extra-anatomical or in situ bypass. There have been reports of endovascular repair for high-risk patients for formal surgical repair. We present a case of a patient with 3 large pseudoaneurysms arising from the right subclavian artery, descending thoracic aorta, and right popliteal artery treated with endovascular and hybrid intervention.

CASE

A 74-year-old male with remote history of coronary artery bypass graft and recent sternoclavicular joint abscess developed 3 concurrent pseudoaneurysms arising from the right subclavian artery, distal descending thoracic aorta, and right popliteal artery. He underwent right axillary to common carotid bypass with endovascular stent graft placement in the distal innominate and proximal subclavian artery, and subsequently had thoracic endovascular aortic repair and right popliteal stent graft. Four months later, he presented with hemoptysis due to compression of the lung secondary to the pseudoaneurysm. He underwent right anterior thoracotomy and debridement of the pseudoaneurysm. Patient recovered from the procedure and discharged.

CONCLUSION

Endovascular repair of mycotic pseudoaneurysm is an acceptable alternative for high-risk patients. Even when open approach became necessarily, endovascular stent graft decreased blood loss and morbidity.

Hybrid Repair of Proximal Subclavian Artery Aneurysm

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 [70-87] years, and the size of their aneurysm was 33.5 [30-45] 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 management of spontaneous axillary artery aneurysm: a case report and review of the literature

INTRODUCTION

Spontaneous atraumatic true axillary artery aneurysm is a relatively unusual disorder. Although most cases are asymptomatic, complications of axillary artery aneurysms may result in acute vascular insufficiency and neurological deficits. Prompt treatment, therefore, should be employed in the management of this condition. To date, the standard treatment for peripheral aneurysms is still surgical resection with end-to-end anastomosis. However, aneurysmectomy and interposition grafting with autologous or artificial vessels are more invasive and time-consuming. The ideal treatment for axillary artery aneurysm should be relatively noninvasive, safe and free of significant complications, cost-effective, cosmetically acceptable, and incur less absence from usual daily activities. Endovascular stent grafts have also been successfully used to treat these aneurysms. Management of select aneurysms using stent grafts has become more prevalent with the developing endoluminal technology.

CASE PRESENTATION

We report a case of a spontaneous atraumatic axillary artery aneurysm where the patient was a 48-year-old ethnic Han Chinese woman with a gradually enlarging left axillary pulsatile mass. She was treated with endovascular stent grafts. The postoperative course of the patient was uneventful during the six-month follow-up.

CONCLUSIONS

We show that there are significant early advantages with the endovascular management technique versus the conventional operation in the management of axillary artery aneurysm.