Endovascular treatment of the subclavian artery aneurysm in high-risk patients – A single-center experience
Abstract
Background/Aim. Subclavian artery aneurysm (SAA) is a rare disease, but with serious complications. Recently, besides open surgical procedure, appearance of the stent-grafts enables endovascular reconstruction. We presented our first experience with endovascular treatment of 6 SAA occurring in five male and one female patient. Methods. All the patients, in our studies, according to ASA classification were at high risk of open repair of SAA. The etiology of all aneurysms was atherosclerotic degeneration of the artery. Two aneurysms were at intrathoracic location, and the other ones were extrathoracic. Symptoms related to SAA were present in two of the patients, compression and chest pain in one, and hemorrhage shock in another one. Other patients were asymptomatic. We preferred the Viabhan endoprosthesis for endovascular repair in 5 cases. In one patient with rupture of SAA, who was at high risk of open repair we performed a combined endovascular procedure. First of all, we covered the origin of the left subclavian artery with thoracic stent graft and after that put two coils in a proximal part of the subclavian artery. Results. There was no operative mortality, and the early patency rate was 100%. The follow-up period was from 3 months to 3 years. During this period, one patient died of heart failure and another one required endovascular reoperation due to endoleak type I. Conclusion. Endovascular treatment is recommended for all patients with SAA whenever it is possible due to anatomical reasons especially in high-risk patients with intrathoracic localization of aneurysm, to prevent potential complications.
References
Dent TL, Lindenauer SM, Ernst CB, Fry WJ. Multiple arterioscle-rotic arterial aneurysms. Arch Surg 1972; 105(2): 338−44.
Wang Z, Yu J, Wang X. Management of subclavian artery aneu-rysm. Chung Hua Wai Ko Tsa Chin 1996; 34: 359−60.
Davidović LB, Marković DM, Pejkić SD, Kovačević NS, Čolić MM, Dorić PM. Subclavian artery aneurysms. Asian J Surg 2003; 26(1): 7−11.
Porcellini M, Selvetella L, Scalise E, Bauleo A, Baldassarre M. Arte-riosclerotic aneurysms of the subclavian artery. Minerva Car-dioangiol 1996; 44(9): 433−6.
May J, White G, Waugh R, Yu W, Harris J. Transluminal place-ment of a prosthetic graft-stent device for treatment of subcla-vian artery aneurysm. J Vasc Surg 1993; 18(6): 1056−9.
MacSweeney ST, Holden A, Harltley D, Lawrence-Brown M. Endo-vascular repair of subclavian artery aneurysm. J Vasc Surg 1996; 24(2): 304−5.
Sullivan TM, Bacharach JM, Perl J, Gray B. Endovascular man-agement of unusual aneurysms of the axillary and subclavian arteries. J Endovasc Surg 1996; 3(4): 389−95.
Salo JA, Ala-Kulju K, Heikkinen L, Bondestam S, Ketonen P, Luosto R. Diagnosis and treatment of subclavian artery aneurysms. Eur J Vasc Surg 1990; 4(3): 271−4.
Kim SS, Jeong MH, Kim JE, Yim YR, Park HJ, Lee SH, et al. Successful treatment of a ruptured subclavian artery aneurysm presenting as hemoptysis with a covered stent. Chonnam Med J 2014; 50(2): 70−3.
Amiridze N, Trivedi Y, Dalal K. Endovascular repair of subcla-vian artery complex pseudoaneurysm and arteriovenous fistula with coils and Onyx. J Vasc Surg 2009; 50(2): 420−3.