Changing Profiles of Diagnostic and Treatment Options in Subclavian Artery Aneurysms

Abstract

The profiles of diagnostic and treatment options of SAAs are changing. Although guidelines considering timing of intervention may not be conducted from available literature, intervention appears to be indicated, especially in distal SAAs, due to the risk of thrombo-embolic complications. Endovascular repair and hybrid procedures appear to be the preferred treatment modalities, due to a lower rate of cardiopulmonary complications.

Open Repair of a 12-cm Posttraumatic Aneurysm of Right Subclavian Artery

“…Clinical presentation varies from asymptomatic mass to compression of the neighboring anatomic structures or distal embolization. Dysphagia, dyspnea, hemoptysis, and hoarseness of voice from esophageal, tracheal, lung, phrenic, and right recurrent laryngeal nerve compression have been described ( 5 ). Thoracic CTA is the preferred imaging modality since it helps for diagnosis and operational approach to subclavian artery aneurysm.…”

“…Vierhout et al ( 5 ) in a 2010 review found 394 cases of subclavian artery aneurysm in 381 patients. Half of them (51%) presented with pulsatile mass, shoulder pain, and non-specific chest pain.…”

Successful Treatment of a Ruptured Subclavian Artery Aneurysm Presenting as Hemoptysis with a Covered Stent

“…The common causes of SAAs were atherosclerosis, thoracic outlet syndrome, infection, trauma, and congenital arterial anomalies such as Marfan syndrome 1,2. In particular, proximal aneurysms were caused by atherosclerosis (19%), collagen disorder (18%), trauma (15%), infection (13%), and in-hospital procedures (12%) 2.…”

“…Although SAAs can be asymptomatic, they can also cause life-threatening complications such as rupture, thrombosis, or embolism and can result in symptoms caused by local compression 2. In a meta-analysis of 394 native SAAs, rupture occurred in 9% of patients, with an associated mortality of 19% 4.…”

“…Although rare, an SAA can cause life-threatening complications such as rupture, thrombosis, and embolism 2. Recently, we experienced a case of a ruptured SAA presenting as hemoptysis, which was successfully treated by endovascular stenting.…”