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      A hybrid operation in a patient with complex right subclavian artery aneurysm

      case-report

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          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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          Percutaneous placement of a balloon-expandable intraluminal graft for life-threatening subclavian arterial hemorrhage.

          Maria Sallee, G Zemel, J Benenati … (1991)
          A balloon-expandable intraluminal graft was percutaneously deployed in the left subclavian artery of a 43-year-old woman. This graft was made of a stainless steel, 30-mm Palmaz balloon-expandable iliac stent completely covered with a thin coat of silicone. The procedure was successful in managing and preventing life-threatening hemorrhage as a large-bore catheter was removed from the subclavian artery via its subcutaneous tunnel. Surgical repair of the high brachial-axillary sheath insertion site was required after percutaneous deployment of the graft. However, the grafting procedure succeeded in obviating a thoracotomy. At follow-up of 6 months, despite diminution in brachial pulse volume recordings, the patient is asymptomatic at rest. She experiences mild fatigue with extremes of upper extremity exercise and declines angiographic follow-up and further intervention.
          Article 0 comments Cited 15 times – based on 0 reviews     Review now
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            Atherosclerotic aneurysm of the intrathoracic subclavian artery: a case report and review of the literature.

            Matthew Dougherty, Keith D Calligaro, Ronald P. Savarese … (1995)
            True aneurysm of the subclavian artery is extremely rare. Excluding the more common aneurysms of an aberrant right subclavian artery, those associated with thoracic outlet syndrome, and posttraumatic "aneurysms," atherosclerosis is the most common cause. Syphilis, tuberculosis, and cystic medial necrosis are less often the cause. These aneurysms can rupture, thrombose, embolize, or cause symptoms by local compression. Surgical treatment is generally indicated, and has evolved from ligation procedures to extirpation or endoaneurysmorrhaphy to the present practice of resection with revascularization. A case of a surgically treated, asymptomatic, atherosclerotic aneurysm of the intrathoracic left subclavian artery is presented, with a review of the English-language literature on the subject.
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              Stent-graft therapy for subclavian artery aneurysms and fistulas: single-center mid-term results.

              Michael D. Dake, Ji Sze, S. P. Mc Kee … (2000)
              To evaluate the potential of covered stents to replace surgery in the treatment of subclavian artery aneurysms and traumatic injuries. Nine patients (five men, four women; age range, 20-83 years; mean, 54 years) with subclavian artery aneurysms (n = 5) or fistulas (n = 4) were treated with stent-grafts. All devices used were custom-made, consisting of polytetrafluoroethylene (PTFE)-covered Palmaz (n = 5), Wallstent (n = 2), Z stents (n = 8), or a polyester-covered Z stent (n = 1). One patient was lost to follow-up after 2 months. All others were followed up with clinical evaluation, computed tomography (CT), and/or ultrasound. All devices were deployed successfully with exclusion of the aneurysms and fistulas. There were two procedure-related complications (22%), consisting of groin pseudoaneurysms requiring surgical repair 3 and 9 days after the procedure. One of those patients required additional oral antibiotic therapy for a postsurgical groin wound infection. One patient developed a stenosis at 12 months, which required angioplasty. The stent-graft thrombosed in one patient because of a kink 2 months after placement, which was successfully treated by thrombolysis and placement of a Wallstent. The primary and secondary patencies are 89% and 100%, respectively, after a mean follow-up of 29 months (2-66 mo). Mid-term results of stent-graft therapy of subclavian artery aneurysms and fistulas are encouraging, with low morbidity and excellent clinical outcome.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Korean Surg Soc
                Journal ID (publisher-id): JKSS
                Title: Journal of the Korean Surgical Society
                Publisher: The Korean Surgical Society
                ISSN (Print): 2233-7903
                ISSN (Electronic): 2093-0488
                Publication date (Print): March 2012
                Publication date (Electronic): 27 February 2012
                Volume: 82
                Issue: 3
                Pages: 195-199
                Affiliations
                Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
                [1 ]Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
                [2 ]Department of Thoracic & Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
                Author notes
                Correspondence to: Dong-Ik Kim. Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea. Tel: +82-2-3410-3467, Fax: +82-2-3410-0040, dikim@ 123456skku.edu
                Article
                DOI: 10.4174/jkss.2012.82.3.195
                PMC ID: 3294115
                PubMed ID: 22403755
                SO-VID: e58fc07f-2a23-4ba9-804c-4516a483ee28
                Copyright © Copyright © 2012, the Korean Surgical Society
                License:

                Journal of the Korean Surgical Society is an Open Access Journal. All articles are distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 18 July 2011
                Date revision received : 16 September 2011
                Date accepted : 05 October 2011
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Surgery
                Keywords: subclavian artery,aneurysm,hybrid operation
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: subclavian artery, aneurysm, hybrid operation

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