Large Right True Subclavian Artery Aneurysm Treated With Hybrid Surgery

Area of Science:

• Vascular Surgery
• Aneurysm Repair
• Cardiovascular Interventions

Background:

• Subclavian artery (SCA) aneurysms are rare vascular conditions, representing less than 1% of all peripheral aneurysms.
• SCA aneurysms require surgical repair due to significant risks of rupture and thromboembolic complications.

Purpose of the Study:

• To present a case of a complex, large right subclavian artery aneurysm in an elderly patient.
• To discuss the surgical management and outcomes of a high-risk patient undergoing innovative SCA aneurysm repair.

Main Methods:

• Retrospective review of electronic medical records.
• Surgical intervention involving innominate and common carotid artery stent graft placement, sac embolization, and carotid to axillary artery bypass.
• Management of post-operative complications including atheroembolic stroke and clopidogrel resistance.

Main Results:

• An 80-year-old female with a complex medical history underwent successful, albeit complicated, surgical repair of a large right SCA aneurysm.
• The patient experienced an atheroembolic multiterritorial stroke and was found to be clopidogrel resistant.
• Recovery was progressing well at 3 months post-discharge to a rehabilitation facility.

Conclusions:

• Complex subclavian artery aneurysms necessitate thorough pre-operative assessment and individualized surgical planning.
• Familiarity with diverse surgical approaches is crucial for optimizing outcomes in challenging vascular cases.
• Careful patient selection and management of potential complications are vital for successful SCA aneurysm repair.