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Tabatabaeishoorijeh A, Haddad P, Chauhan Y, Atkins MD, Rahimi M. Open repair of a proximal left subclavian artery mycotic aneurysm with median claviculectomy. J Vasc Surg Cases Innov Tech 2024; 10:101374. [PMID: 38130359 PMCID: PMC10731596 DOI: 10.1016/j.jvscit.2023.101374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023] Open
Abstract
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.
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Affiliation(s)
- Ahmad Tabatabaeishoorijeh
- School of Engineering Medicine, Texas A&M University, Houston, TX
- School of Medicine, Texas A&M University, Bryan, TX
- College of Engineering, Texas A&M University, Bryan, TX
| | - Paul Haddad
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX
| | - Yusuf Chauhan
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX
| | - Marvin D. Atkins
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX
| | - Maham Rahimi
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX
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Operative repair of right intrathoracic subclavian artery aneurysms in patients with genetic arteriopathy. J Vasc Surg Cases Innov Tech 2022. [PMID: 37496653 PMCID: PMC10366541 DOI: 10.1016/j.jvscit.2022.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
True intrathoracic subclavian artery aneurysms (SCAAs) are rare and have various etiologies. Right intrathoracic SCAAs pose specific anatomic challenges to repair. We present three different operative approaches, open, endovascular, and hybrid repair, for the repair of a right intrathoracic SCAA in three patients with genetic arteriopathy: Marfan syndrome, vascular Ehlers-Danlos syndrome, and unspecified Ehlers-Danlos syndrome, respectively. These cases demonstrate an individualized operative approach based on the genetic diagnosis for each patient presenting with a right intrathoracic SCAA.
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Claviculectomy for exposure and redo repair of expanding, recurrent right subclavian aneurysm. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:694-697. [PMID: 34746533 PMCID: PMC8556485 DOI: 10.1016/j.jvscit.2021.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022]
Abstract
Subclavian artery aneurysms (SAAs) are rare, and their repair can be technically complex. We have reported the redo repair of a large, expanding, right SAA after primary repair consisting of total aortic arch replacement with bilateral subclavian artery ligation and bypass. The redo repair used claviculectomy to facilitate exposure, ligation of the right deep cervical and internal thoracic arteries from within the aneurysm sac, and revision of the previous axillary artery bypass that had thrombosed owing to the mass effect of the expanding SAA. Claviculectomy can facilitate repair of large SAAs that are poorly suited to more routine exposure approaches, with acceptable risk and functional outcomes.
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Davidovic LB, Zlatanovic P, Ducic S, Koncar I, Cvetic V, Kuzmanovic I. Single center experience in the management of a case series of subclavian artery aneurysms. Asian J Surg 2019; 43:139-147. [PMID: 31113693 DOI: 10.1016/j.asjsur.2019.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/15/2019] [Accepted: 04/12/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE Subclavian artery aneurysms (SAAs) are rare, but they may cause life- and limb-threatening complications. METHODS Retrospective review was performed of all SAA patients that underwent treatment at the Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade between January 1st 2006 and January 1st 2018. The paper includes analysis of etiology and therapeutic options based on the experience from our institution. RESULTS Twenty (80%) of SAAs involved extrathoracic (ET), while five (20%) intrathoracic (IT) segment. Out of total five IT SAAs, two were asymptomatic (40%), one had dyspnea (20%), while two (40%) had hematothorax due to rupture. Seven (35%) patients with ET SAA had shoulder pain and pulsatile mass, five (25%) acute, seven (35%) had chronic limb ischemia, while one was asymptomatic (5%). Two IT SAAs were treated with open surgery (OS). Other three cases underwent hybrid procedure. One case with ET SAA was treated endovascularly due to hostile anatomy, while in all other 19 cases of ET SAAs open repair was performed, which included: graft interposition in 10 (52.63%), end-to-end anastomosis in 7 (36.84%) cases, while bypass procedure in 2 (10.52%) patients. One of our patients (4%) died during the first 30 postoperative days. CONCLUSIONS SAAs are rare, however because of their natural history they have huge clinical significance. OS is the method of choice in cases of ET SAAs caused by TOS. Endovascular and hybrid treatment decrease significantly perioperative morbidity and mortality rates in cases of intrathoracic SAAs and thus should be the first option.
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Affiliation(s)
- Lazar B Davidovic
- Faculty of Medicine, University of Belgrade, Serbia; Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Petar Zlatanovic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.
| | - Stefan Ducic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Igor Koncar
- Faculty of Medicine, University of Belgrade, Serbia; Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Vladimir Cvetic
- Faculty of Medicine, University of Belgrade, Serbia; Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Ilija Kuzmanovic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
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Ramtoola MT, Bhatti M, Shetty R. A case report of a ruptured subclavian artery aneurysm presenting to the emergency department. Clin Case Rep 2019; 7:797-800. [PMID: 30997088 PMCID: PMC6452447 DOI: 10.1002/ccr3.2098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 02/17/2019] [Indexed: 11/24/2022] Open
Abstract
Subclavian artery aneurysms are uncommon and present a diagnostic dilemma. Our patient attended with life-threatening rupture, requiring prompt management. However, lack of on-site facilities and specialist input posed a logistical challenge. The patient was stable enough to allow an urgent transfer to a specialist unit for successful endovascular repair.
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Affiliation(s)
| | - Mubashir Bhatti
- Department of Emergency Medicine, Fairfield General HospitalPennine Acute NHS TrustBuryUK
| | - Ritesh Shetty
- Department of Emergency Medicine, Fairfield General HospitalPennine Acute NHS TrustBuryUK
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Hybrid Treatment of a True Right Subclavian Artery Aneurysm Involving the Vertebral Artery using a Covered Stent. Ann Vasc Surg 2018; 53:273.e7-273.e11. [DOI: 10.1016/j.avsg.2018.05.074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/14/2018] [Accepted: 05/21/2018] [Indexed: 12/26/2022]
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Baikoussis NG, Argiriou O, Argiriou M, Psevdi A, Kratimenos T, Dedeilias P. Hybrid treatment of a true thyreocervical trunk aneurysm in a patient with Type B aortic dissection. Ann Card Anaesth 2016; 19:363-6. [PMID: 27052087 PMCID: PMC4900364 DOI: 10.4103/0971-9784.179621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We would like to describe a case with a complex aortic disease treated in hybrid fashion. We present an interesting case of a 65-year-old man with a medical history of hypertension, hyperlipidemia, and coronary artery disease percutaneously treated. An acute Type B aortic dissection occurred and treated with the implantation of a stent-graft which occluded the left subclavian artery due to its extension to the aortic arch. This event required a carotid-subclavian artery bypass due to ischemia of the left arm. An aneurysm in the innominate artery also detected, was treated with another stent-graft implantation 3 months later. At 5-year follow-up, an aneurysm of the thyreocervical trunk was found while the stent-graft of the aorta was well-tolerated without endoleak and the carotid-subclavian graft was patent. The aneurysm was asymptomatic but considering the risk of spontaneous rupture of an aneurysm of this size, elective surgery was indicated. Because the aneurysm was very close to the brachiocephalic bifurcation, open surgical repair would require a sternotomy. The right common carotid artery and right subclavian artery were exposed. The thyrocervical trunk, right internal mammary artery and right vertebral artery were occluded by ligations to isolate the aneurysm. An 8-mm Dacron graft was anastomosed end-to-end to the distal part of subclavian artery. We would like through this case, discuss the role of the hybrid cardiovascular surgery to minimize the postoperative complications in complex cardiovascular pathology. We also discuss the international bibliography about the thyreocervical trunk aneurysm and the treatment options.
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Carotid Subclavian Bypass and Stent Grafting for Mycotic Pseudoaneurysm of Right Subclavian Artery. Ann Vasc Surg 2015; 29:1448.e11-4. [DOI: 10.1016/j.avsg.2015.03.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 03/21/2015] [Accepted: 03/26/2015] [Indexed: 11/19/2022]
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Urgent Endovascular Treatment of Proximal Right Subclavian Artery Pseudoaneurysm Using Kissing Technique. Ann Vasc Surg 2015; 29:1319.e1-4. [DOI: 10.1016/j.avsg.2015.02.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 02/08/2015] [Accepted: 02/13/2015] [Indexed: 11/19/2022]
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Abstract
Peripheral arterial aneurysms are uncommon; for some aneurysm types, data are limited to case reports and small case series. There is no Level A evidence in most cases to determine the choice between open or endovascular intervention. The evolution of endovascular technology has vastly improved the armamentarium available to the vascular surgeon and interventionalists in the management of these rare and unusual aneurysms. The choice of operative approach will ultimately be determined on an individual basis, dependent on the patient risk factors, and aneurysm anatomy. After consideration, some aneurysms (femoral, subclavian, carotid and ECAA) fare better with an open first approach; renal, splenic and some visceral artery aneurysms do better with an endovascular first approach. In our practice PAAs are treated with an endovascular first approach. For these rare conditions, both open and endovascular therapy will continue to work in harmony to enhance and extend the capabilities of modern surgical management.
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Affiliation(s)
- Irwin V Mohan
- Westmead Hospital, University of Sydney Medical School, Sydney, NSW 2145, Australia.
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Morisaki K, Kobayashi M, Miyachi H, Maekawa T, Tamai H, Takahashi N, Watanabe Y, Morimae H, Ihara T, Kodama A, Narita H, Banno H, Yamamoto K, Komori K. Subclavian artery aneurysm in Marfan syndrome. Ann Vasc Surg 2012; 26:731.e1-4. [PMID: 22664289 DOI: 10.1016/j.avsg.2011.09.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 09/02/2011] [Accepted: 09/14/2011] [Indexed: 11/26/2022]
Abstract
We present a case of a left subclavian artery aneurysm in a 48-year-old man with Marfan syndrome. Aneurysms of the subclavian artery are rare in patients with Marfan syndrome. Resection of the aneurysm and interposition with a synthetic graft were performed through a supra- and infraclavicular incision, without resecting the clavicle. Histological findings were compatible with Marfan syndrome. In patients with Marfan syndrome, regular follow-up is important because of the occurrence of peripheral aneurysms other than the aorta.
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Affiliation(s)
- Koichi Morisaki
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Nonaka M, Nakatsuka D, Okada T, Sekine Y, Iwakura A, Yamanaka K. Isolated aneurysm of the proximal right subclavian artery treated with consideration toward cerebral circulation and vasculature. Gen Thorac Cardiovasc Surg 2012; 61:292-5. [DOI: 10.1007/s11748-012-0138-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 07/30/2012] [Indexed: 12/01/2022]
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Roh YN, Park KB, Do YS, Kim WS, Kim YW, Kim DI. A hybrid operation in a patient with complex right subclavian artery aneurysm. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 82:195-9. [PMID: 22403755 PMCID: PMC3294115 DOI: 10.4174/jkss.2012.82.3.195] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 09/16/2011] [Accepted: 10/05/2011] [Indexed: 11/30/2022]
Abstract
We report a hybrid surgery including endovascular aneurysm repair and debranching procedures to treat a patient with a complex right subclavian artery aneurysm. The patient was a 70-year-old woman who presented with dry cough and hoarseness. The aneurysm was characterized by the absence of a proximal neck, and involvement of the origin of the right vertebral artery. She underwent carotid-vertebral artery bypass, stent graft from the innomiate artery to the common carotid artery and carotid-axillary artery bypass. Great saphenous vein was used for the carotid-vertebral artery bypass and 7 mm reinforced polytetrafluoroethylene graft was used for the carotid-axillary artery bypass. The postoperative course was uneventful.
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Affiliation(s)
- Young-Nam Roh
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Ullery BW, Foley PJ, Brinster CJ, Pochettino A, Fairman RM. A novel two-stage surgical approach for the treatment of symptomatic supra-aortic artery aneurysms. Vascular 2011; 20:236-40. [PMID: 22030356 DOI: 10.1258/vasc.2011.cr0287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We describe the case of a 45-year-old man with a unique constellation of supra-aortic artery aneurysms detected by chest X-ray during work-up for chronic cough. During his diagnostic work-up, the patient suffered an embolic stroke likely secondary to disrupted plaque originating in an aneurysmal right vertebral artery. Endovascular repair was not a viable option due to the diffuse and bilateral nature of aneurysmal disease, including involvement of the innominate and right carotid and vertebral arteries. The patient was successfully treated with a two-stage open surgical approach involving an initial right carotid artery to vertebral artery bypass and subsequent in situ reconstruction utilizing a bifurcated Dacron graft sewn to the proximal aortic arch with distal extension to the right common carotid and axillary arteries.
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Affiliation(s)
| | - Paul J Foley
- Division of Vascular Surgery and Endovascular Therapy
| | | | - Alberto Pochettino
- Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Tachtsi MD, Pitoulias GA, Fycatas P, Kalogirou T, Papadimitriou DK. Subclavian Artery Aneurysm Due to Clavicle Fracture. Ann Vasc Surg 2011; 25:984.e5-7. [DOI: 10.1016/j.avsg.2011.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 03/28/2011] [Accepted: 04/11/2011] [Indexed: 11/25/2022]
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Bruen KJ, Feezor RJ, Lee WA. Hybrid management of proximal right subclavian artery aneurysms. J Vasc Surg 2011; 53:528-30. [DOI: 10.1016/j.jvs.2010.07.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 07/13/2010] [Accepted: 07/17/2010] [Indexed: 11/15/2022]
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Vierhout B, Zeebregts C, van den Dungen J, Reijnen M. Changing Profiles of Diagnostic and Treatment Options in Subclavian Artery Aneurysms. Eur J Vasc Endovasc Surg 2010; 40:27-34. [DOI: 10.1016/j.ejvs.2010.03.011] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 03/09/2010] [Indexed: 11/24/2022]
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Surgical approach to left subclavian artery aneurysm in Marfan syndrome. Gen Thorac Cardiovasc Surg 2009; 57:376-8. [DOI: 10.1007/s11748-008-0389-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Accepted: 12/09/2008] [Indexed: 10/20/2022]
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Kopp R, Meimarakis G, Strauss T, Hatz R, Walter Jauch K, Waggershauser T. Combined supra-aortic extra-anatomic revascularization and endovascular hybrid procedure for recurrent hemoptysis caused by a symptomatic aneurysm of the right subclavian artery. Vascular 2009; 17:172-5. [PMID: 19476752 DOI: 10.2310/6670.2008.00058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Acute hemoptysis might be caused by aneurysms of the subclavian artery. We report a 75-year-old female patient presenting with recurrent hemoptysis, dyspnea, fever, and episodes of unclear pneumonia. Further examination revealed a large intrathoracic aneurysm of the right subclavian artery. After an initial transfemoral interventional attempt to occlude the entry of the aneurysm, the patient developed persistent thoracic pain. The patient was then treated by a combined extrathoracic hybrid procedure with a left to right carotid-carotid-axillary artery bypass and an endovascular aneurysm exclusion by insertion of two iliac artery occluder stent grafts in the proximal brachiocephalic trunk and the distal right subclavian artery. After this combined intervention, hemoptysis disappeared, and the patient recovered remarkably during a follow-up of 24 months.
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Affiliation(s)
- Reinhard Kopp
- Department of Vascular Surgery, Klinikum Grosshadern, University of Munich, Munich, Germany.
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Tam K, Seneviratne K, Pathak R, Jayatunga A. An acutely ischaemic hand in a young adult due to subclavian artery aneurysm (SAA) caused by a cervical rib: A case report. CASES JOURNAL 2008; 1:140. [PMID: 18771598 PMCID: PMC2542346 DOI: 10.1186/1757-1626-1-140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 09/04/2008] [Indexed: 11/10/2022]
Abstract
INTRODUCTION True subclavian artery aneurysms are relatively rare lesions. Thoracic outlet compression is responsible for 75% of aneurysms. They are formed as a result of compression by, for example a cervical rib. CASE PRESENTATION We present a case of subclavian artery aneurysm secondary to a cervical rib in a 25-year-old young Asian adult, who presented with an acutely ischaemic upper limb. A Computed Tomography angiogram revealed a right sided cervical rib and sacular aneurysm in the mid-portion of the subclavian artery. CONCLUSION Although it is a rare condition, it is important to be aware especially in the young age group. Surgical management has very favourable outcomes in these patients.
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Affiliation(s)
- Karen Tam
- Vascular Surgical Department, Russells Hall Hospital, Dudley, UK.
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