Successful treatment of giant left subclavian artery pseudoaneurysm abutting the arch of the aorta and descending aorta

Abstract

A 28-year-old woman presented with 3-month history of fever of unknown origin and progressively increasing cough. She was diagnosed with pulmonary tuberculosis on bronchial lavage cultures. A chest X-ray performed on follow-up showed a new opacity in the left apical area of the chest. Computed tomography scan of chest showed a large 10 cm pseudoaneurysm of the left subclavian artery 1 cm from its take off from the arch of the aorta. The pseudoaneurysm was approached through a left posterolateral thoracotomy and opened following a proximal and distal control. A 3 cm longitudinal defect was identified in the subclavian artery within its intrathoracic portion. This was debrided and repaired with an autologous pericardial patch. The patient had an uneventful recovery and remained well on follow-up.

Delayed Endovascular Stenting of Right Subclavian Artery Pseudoaneurysm Caused by Gunshot Accident in a Syrian Refugee: A Case Report

“…Currently, treatment options include open surgery, endovascular surgery, or thrombin injection. 5,9,11,12 In a study that compared the outcome of surgical and endovascular treatment of 27 patients with subclavian or axially artery, authors suggested that choosing treatment modality was based on surgeons' preference. Most importantly, the study also suggested that the 1-year patency rate of stents or grafts was not significantly different between surgical and endovascular approaches.…”

“…3 Complications associated with surgical repair include embolism formation, spontaneous bleeding, prolonged anesthesia surgery time, and subsequent delay in patient discharge. 5 Recently, there have been several reports documenting successful treatment of pseudoaneurysm cases using less invasive endovascular approaches. The main aim of this case report is to describe the successful management of a delayed right subclavian artery pseudoaneurysm caused by a gunshot wound that was associated with right brachial panplexopathy.…”

Proximal flow control with a balloon during the treatment of left subclavian artery aneurysmsreply

“…We read with a great interest the manuscript entitled, “Successful treatment of giant left subclavian artery pseudoaneurysm abutting the arch of the aorta and descending aorta” by Khan et al . [ 1 ] The authors presented treatment of a giant, most probably, mycotic pseudoaneurysm of the intrathoracic left subclavian artery through thoracotomy with an autologous pericardial patch. In addition, they mentioned about other treatment options briefly such as endovascular stent graft implantation[ 2 ] and ligation[ 1 ] with or without an anatomic/extra-anatomic bypass.…”

“…It is known that, in patients with proximal left subclavian artery aneurysms, the orifice of the subclavian artery may be very fragile. [ 1 ] It may be easily injured leading to catastrophic complications during surgical dissection. A balloon catheter placed prior to the surgery at the orifice of the left subclavian artery ready to be inflated in case of a rupture can be lifesaving.…”

“…That is an excellent suggestion and we agree that the balloon occlusion of the left subclavian orifice is a safe option to get proximal control. [ 1 2 ] However, that depends upon the ease with which one can gain proximal control on the arch of the aorta. Balloon occlusion in our case would have been an option if there was extensive inflammation on the arch of the aorta and the dissection to get proximal control on the arch was challenging.…”