Successful surgical treatment of right subclavian artery aneurysm with a hypoplastic left vertebral artery using temporary cerebral perfusion to prevent cerebral ischemia

Abstract

A 71-year-old man had a right subclavian artery aneurysm (dimension, 30 × 38 mm) that was adjacent to the right common carotid artery and exceedingly close to the right vertebral artery. The patient had a marked hypoplastic left vertebral artery, dominant right vertebral artery, and an incompletely formed and underdeveloped circle of Willis in the skull. While performing a median sternotomy and supraclavicular incision during the operation, we used temporal shunting for the cerebral perfusion. The subclavian artery aneurysm was resected, and a 10-mm diameter woven Dacron graft was used for reconstructing the subclavian artery. The postoperative course was uneventful, and the patient was discharged from the hospital 18 days after surgery. Temporal shunting for maintaining cerebral perfusion was useful in preventing cerebral ischemia, and the median sternotomy plus supraclavicular incision approach afforded an unobstructed view of the surgical field.

Keywords: cerebral artery perfusion; hypoplastic vertebral artery; subclavian artery aneurysm.

Fig. 1

A: Computed tomographic analysis showing a right subclavian artery aneurysm, 30 × 38 mm (indicated by arrowhead). B: Right vertebral artery branched at the periphery of the aneurysm (indicated by arrowhead).

Fig. 2

A: Magnetic resonance angiography showing hypoplasia of the left vertebral artery (indicated by arrowhead). B: Poor collateral circulation through the circle of Willis.

Fig. 3

Brachiocephalic artery and distal site of right subclavian artery were clamped during anastomosis. A y-shape cardioplegia needle was inserted at the ascending aorta, and right common carotid artery and vertebral artery perfusion was performed.

Fig. 4

Reconstruction of the right subclavian artery with a 10-mm woven Dacron graft.