Claviculectomy for exposure and redo repair of expanding, recurrent right subclavian aneurysm

Abstract

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Open repair of a proximal left subclavian artery mycotic aneurysm with median claviculectomy

“… 3 , 11 In contrast, for noninfectious subclavian artery aneurysms, endovascular, open, and hybrid approaches have had similar morbidity and mortality rates. 2 , 4 , 5 , 12 , 13 …”

“…Access options and the various methods of exposure for open repair of a SAMA depend greatly on the location of the aneurysm and the intra- or extrathoracic involvement. 2 , 4 , 5 For proximal subclavian artery aneurysms, the method of exposure includes, but is not limited to, thoracotomy, sternotomy, and supraclavicular access. For the distal two thirds segment of the subclavian artery, supraclavicular exposure is often used.…”

“…Despite the lack of use of claviculectomy in SAMA access, this is an effective treatment for diseases affecting the sternoclavicular joint. 4 , 14 Patients with an excised medial clavicle maintain an unimpeded shoulder mobility without any significant deformities or cosmetic shortcomings. 4 , 14 , 15 Compared with claviculectomy, which has no clear contraindications, other methods of exposure such as thoracotomy or sternotomy have an increased risk of postoperative pulmonary and esophagopleural complications, especially in already vulnerable patients.…”

“… 4 , 14 Patients with an excised medial clavicle maintain an unimpeded shoulder mobility without any significant deformities or cosmetic shortcomings. 4 , 14 , 15 Compared with claviculectomy, which has no clear contraindications, other methods of exposure such as thoracotomy or sternotomy have an increased risk of postoperative pulmonary and esophagopleural complications, especially in already vulnerable patients. 2 In the present case, the comorbidities associated with a high-risk patient directed the repair away from more invasive methods, such as thoracotomy or sternotomy, and toward the alternative method of claviculectomy to prevent intra- and postoperative complications.…”

“… 1 , 2 Although patients are often poor surgical candidates, more invasive methods of exposure such as thoracotomy or median sternotomy are still used in the treatment of SAMAs. 2 , 3 , 4 , 5 , 6 An anatomic exposure using claviculectomy has remained underused and rather controversial. We report a median claviculectomy method of exposure for the successful repair of a 1.9-cm left SAMA distal to the left vertebral artery with a subclavian artery to axillary artery bypass using the right great saphenous vein.…”