Carotid-Axillary Bypass and Debridement for a Mycotic Aneurysm of the Left Subclavian Artery

Abstract

Mycotic subclavian aneurysms are rare, and their presence typically mandates urgent repair due to the associated high risk of rupture and mortality. A multi-disciplinary team effort is of utmost importance in ensuring favorable results. In this case report, we present a 79-year-old male with a rapidly enlarging mycotic left subclavian artery aneurysm secondary to a retrosternal abscess and left sternoclavicular septic arthritis, who underwent aneurysmal exclusion, a left carotid-left axillary bypass and pectoralis muscle flap coverage with a good outcome.

Mycotic subclavian artery aneurysms: a scoping review

“…Initial antimicrobial therapy was mentioned for 18 patients [7-9, 12, 16, 18, 19, 21, 23, 24, 26, 29, 31-33, 35, 37]. The antibacterial drugs were antibacterial agents (cefotaxime, ceftazidime, cephalexin, meropenem, or vancomycin) for 14 (77.8%) patients, both antibacterial Pleural effusion (1) [31] Bronchial wash and brushings (1) [27] Unknown (4) [9,32,34,37] Methicillin sensitive staphylococcus aureus [8,11,17,22,28,30] 6 Blood (4) [11,17,22,28] Hickman line tip (1) [11] Pus (1) [22] Surgical specimen (1) [30] Unknown (1) [8] Wound tissue (1) [28] Surgical specimen (1) [17] Escherichia coli [16,24] 2 Blood (1) [24] Urine (1) [24] Pus (1) [16] Methicillin-resistant staphylococcus aureus [23,25] 2 Blood (1) [23] Wound tissue (1) [25] Staphylococcus aureus [35] 2 Blood (1) [35] Wound tissue (2) [35] Streptococcus viridans [15,35] 2 Blood (1) [15] Wound tissue (1) [35] Streptococcus pneumoniae [10] 2 Pus (1) [29] Surgical specimens (1) [10] Burkholderia pseudomallei [33] 1 Blood (1) [33] Surgical specimen (1)…”

“…In 3 patients, it was described as "increased" or "normal", and in the remaining 13 patients, a concrete value was given. A normal white blood cell count was noted in 4 (25%) patients [9,15,18,29], leukopenia was present in 2 (12.5%) patients [24,37], and leukocytosis was present in 10 (62.5%) patients [7,10,14,19,23,[25][26][27][28]33]. The mean white blood cell count was 11.2 ±6.3 (range: 0.8-21.5; median: 12.8) × 10 9 /l (n = 13).…”

“…The location of the SAA was not mentioned for 1 patients. In the remaining 32 patients, the aneurysms were derived from the left subclavian artery in 14 (43.8%) patients [9,10,12,15,19,21,24,25,28,29,32,36,37], and from the right in 18 (56.3%) patients [7, 8, 11, 14, 16-18, 20, 22, 23, 26, 27, 30, 31, 33-35] (one of which was from the right aberrant subclavian ar-tery [7]). In the case of two aneurysms, their extra-or intrathoracic positions were not mentioned.…”

“…As regards the remaining 33 aneurysms, 12 (36.4%) were extrathoracic [7,10,14,18,21,23,25,30,31,35,36] and 21 (63.6%) (including 1 recurrent one) were intrathoracic [8, 9, 11, 12, 15-17, 19, 20, 22, 24-29, 32, 33, 35, 37]. 33 aneurysms (including 31 primary and 2 recurrent) were pseudoaneurysms [8][9][10][11][12][13][14][15][16][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37], whereas 2 were true aneurysms [7,17]. In 5 (15.2%) patients, the aneurysms were ruptured [12,14,20,30,34].…”

“…Local abscess formation was observed in 7 (21.2%) patients [10,14,16,19,22,24,28], aneurysmal thrombus in 7 (21.2%) patients [8,9,11,16,18,24,31], and aneurysmal expansion in 9 (27.3%) patients [9,11,23,25,26,28,30,33,36].…”