Management of iatrogenic subclavian artery pseudoaneurysms

To report our experience in the management of iatrogenic subclavian artery pseudoaneurysms (SAPs).

During a 6-year period, 5 patients were treated urgently for SAP.

Two patients presented with rupture, 2 with dyspnea, whereas 1 had unremitting severe pain. Three patients underwent preoperative computed tomography angiography and 2 digital subtraction angiography. Three patients were treated with an open surgical procedure, whereas 2 were managed by endovascular means. A combined supraclavicular and/or infraclavicular approach was used in 2 patients, whereas a midsternotomy was mandatory to achieve proximal control in one. A combined transfemoral and/or brachial approach was used in both patients treated endovascular. No perioperative deaths or procedure-related complications occurred. All symptoms were relieved, whereas the median hospital stay was 8 days. During a mean follow-up period of 20.4 ± 10 months, none of the patients needed any reintervention.

Iatrogenic SAPs constitute a clinical entity that may need surgical treatment, especially in the presence of symptoms. In relatively stable patients with no major compression issues, stenting could be considered as an adequate therapy for these situations. Open surgical repair should be considered when there is significant compression of adjacent structures or failure of the endovascular approach.