Infected false aneurysms of the subclavian artery: A complication in drug addicts

Miller, Charles M.; Sangiuolo, Paolo; Schanzer, Harry; Haimov, M; McElhinney, A. James; Jacobson, Julius H.

doi:10.1067/mva.1984.avs0010684

Cited by 9 publications

(8 citation statements)

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“…A review of the English literature reveals this as one of the few cases of a subclavian artery aneurysm presenting with massive hemoptysis. Of the 12 cases of subclavian aneurysm presenting with hemoptysis in the English literature, 3 cases involved the right subclavian and 9 involved the left subclavian artery [3][4][5][6][7][8][9][10][11][12][13] (see ►Table 1). At least three cases were fatal before receiving intervention.…”

Section: Discussionmentioning

confidence: 99%

Subclavian Aneurysm Presenting with Massive Hemoptysis: A Case Report and Review of the Literature

et al. 2013

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Aneurysms of the proximal subclavian artery are rare. Reported etiologies of this unusual clinical problem include arteriosclerosis, trauma, fibrodysplastic disease, degenerative connective tissue disorders, cervical ribs in association with thoracic outlet syndrome, congenital lesions, and infection. We present a case of a 70-year-old male with an extensive medical history who presented to an outside hospital with massive hemoptysis. His past medical history was significant for coronary artery disease and he had undergone coronary revascularization several years prior with a left internal mammary artery (LIMA) to left anterior descending (LAD) coronary artery bypass graft as well as a saphenous vein graft to the obtuse marginal branch (OMB) of the left circumflex coronary artery. His medical history was also notable for end stage renal disease, diabetes, hypertension, paroxysmal atrial fibrillation, and cardiomyopathy with left ventricular ejection fraction of 40%. Notably, he had complete heart block with pacemaker implantation two years before, then requiring explantation due to methicillin-resistant Staphylococcus aureus (MRSA) infection and subsequent replacement with epicardial nonintravascular leads.Chest CT scan revealed a pseudoaneurysm originating from the proximal left subclavian artery measuring 2.2 Â 2.9 cm with adjacent ground-glass opacity and consolidation of the lung (►Figs. 1 and 2). He had persistent hemoptysis but remained hemodynamically stable and was transferred to our facility for further management. An angiogram confirmed the subclavian artery aneurysm (►Fig. 3). Coronary angiography was pursued to delineate coronary artery anatomy. There was no significant left main coronary disease. There was an occluded vein graft with the OMB filling by right to left collaterals and a widely patent LIMA to LAD Keywords ► subclavian ► aneurysm ► hemoptysis ► hybrid ► endovascular repair AbstractWe present a case of a 70-year-old male with a past medical history of coronary artery bypass grafting and end stage renal disease who presented with massive hemoptysis. He had a history of methicillin-resistant Staphylococcus aureus endocarditis, with infection and removal of endocardial pacing leads. His work-up revealed a 2.9-cm proximal left subclavian artery aneurysm. Bronchoscopy confirmed bright red blood in the left upper lobe bronchus and coronary angiography confirmed a patent left internal mammary artery (LIMA) to left anterior descending bypass. Because of the consideration of maintaining coronary perfusion via the LIMA while excluding the subclavian aneurysm, he underwent a left carotid to left axillary artery bypass graft followed by deployment of an Amplatzer II vascular plug just distal to the aneurysm. A thoracic endograft was then deployed to exclude the origin of the subclavian. A review of the literature reveals hemoptysis as a rare presentation of a subclavian aneurysm. We discuss approaches to this challenging clinical problem, ranging from open repair to hybrid approaches.

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Section: Discussionmentioning

confidence: 99%

Subclavian Aneurysm Presenting with Massive Hemoptysis: A Case Report and Review of the Literature

et al. 2013

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“…15e 32 Symptoms of local compression were atypical in many cases. In this context, compression of the stellate ganglion induced Horner syndrome 18,20,22,30,32e35 or facial anhydrosis, 18,22,36 while recurrent laryngeal nerve compression caused hoarseness. 7,18,32,34,37e40 Dysphagia and dyspnoea, due to compression of the oesophagus and trachea, respectively, have also been reported.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Systemic complications, such as massive coagulopathy, acute tubular necrosis and cerebrovascular accidents, were all reported once. 18,36,59 Pulmonary complications, including a chylothorax 85 and an oesophagopleural fistula 38 occurred in 5% of patients and was often related to trauma. Paraesthesia due to a brachial cord lesion (3%) may be temporary 17,19,86 or persistent.…”

Section: Conventional Surgical Repairmentioning

confidence: 99%

Changing Profiles of Diagnostic and Treatment Options in Subclavian Artery Aneurysms

Vierhout¹,

Zeebregts

Dungen

et al. 2010

European Journal of Vascular and Endovascular Surgery

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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.

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“…The majority of pseudoaneurysms develop in the femoral artery due to its close proximity to the femoral vein, although upper limb vessels are also at risk. 4,5…”

Section: Infected Pseudoaneurysmsmentioning

confidence: 99%

Arterial Consequences of Recreational Drug Use

Coughlin

Mavor

2006

European Journal of Vascular and Endovascular Surgery

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Infected false aneurysms of the subclavian artery: A complication in drug addicts

Cited by 9 publications

References 0 publications

Subclavian Aneurysm Presenting with Massive Hemoptysis: A Case Report and Review of the Literature

Subclavian Aneurysm Presenting with Massive Hemoptysis: A Case Report and Review of the Literature

Changing Profiles of Diagnostic and Treatment Options in Subclavian Artery Aneurysms

Arterial Consequences of Recreational Drug Use

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