Repair of Multiple Subclavian and Axillary Artery Aneurysms in a 58-Year-Old Man with Marfan Syndrome

Abstract

Dilation of the ascending aorta and aortic dissections are often seen in Marfan syndrome; however, true aneurysms of the subclavian and axillary arteries rarely seem to develop in patients who have this disease. We present the case of a 58-year-old man with Marfan syndrome who had undergone a Bentall procedure and thoracoabdominal aortic repair for an aortic dissection and who later developed multiple aneurysmal dilations of his right subclavian and axillary arteries. The aneurysms were successfully repaired by means of a surgical bypass technique in which a Dacron graft was placed between the carotid and brachial arteries. We also discuss our strategy for determining the optimal surgical approach in these patients.

Successful repair of a popliteal aneurysm with saphenous vein graft in a patient with Marfan syndrome

“…The best reconstructive option for PAAs in MFS patients remains unclear. Endovascular stents are relatively contraindicated because of their theoretically poor stability and limited data available on the exertion of persistent radial forces in an inherently weak artery 3, 6, 14, 19. Ince et al 7 described six patients who underwent aortic stent grafting; only two (33%) had primary success and one died secondary to aortic rupture.…”

“…Ohyama et al 20 excised an internal carotid artery aneurysm with end-to-end anastomosis with no abnormality 13 months postoperatively. Dolapoglu et al 3 bypassed subclavian and axillary artery aneurysms with a 10-mm polyester graft, and Haruki et al 6 repaired an axillary artery aneurysm with an 8-mm polyester graft. Hatrick et al 21 successfully bypassed a superficial femoral artery aneurysm with reversed saphenous vein graft but had only 14 days of follow-up.…”

“…Marfan syndrome (MFS) is an autosomal disorder caused by mutations in the fibrillin 1 gene ( FBN1 ), leading to decreased elasticity of the arterial media 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15. Thoracic aortic aneurysms and dissections are predominantly seen 1, 4, 5, 7, 11, 12, 13.…”

“…Evidence-based treatment options for peripheral artery disease, in particular infrainguinal disease, are limited. Endovascular interventions are relatively contraindicated because of the risk of damaging an inherently weak artery 3, 6, 8, 14. The best conduit for reconstruction is unknown; synthetic grafts have inferior long-term patency rates, and there is concern that vein grafts may become aneurysmal 16, 17…”