Hybrid Repair of Proximal Subclavian Artery Aneurysm

Abstract

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.

Keywords: aneurysm; endovascular; subclavian artery; vertebral artery.

Fig. 1

Case 3 (76 y.o., male, left subclavian artery aneurysm) RAxA: right axillary artery; LCAA: left common carotid artery; LAxA: left axillary artery.

Fig. 2

Case 4 (72 y.o., male, right aberrant subclavian artery aneurysm) RCCA: right common carotid artery, right subclavian artery; AAA: abdominal artery aneurysm; LCCA: left common carotid artery; LSCA: left subclavian artery.

Fig. 3

Case 5 (87 y.o., female, right subclavian artery aneurysm) SVG: saphenous vein graft; RCAA: right common carotid artery; RVA: right vertebral artery.