Delayed Surgical Management of a Ruptured Traumatic Right Proximal Subclavian Artery Pseudoaneurysm in a...

True subclavian artery aneurysms are extremely rare, accounting for less than 1% of all peripheral arterial aneurysms, whereas axillary artery pseudoaneurysms occur more frequently, typically following trauma or iatrogenic injury. The coexistence of both lesions is exceedingly uncommon and poses diagnostic and therapeutic challenges, especially in resource-limited settings.

A 57-year-old female presented with a progressively enlarging, painful swelling in the left infraclavicular and axillary regions, associated with paresthesia of the left upper limb. She had no history of trauma, vascular intervention, or connective tissue disorder. Examination revealed firm, pulsatile swellings with diminished distal pulses. Doppler ultrasonography suggested aneurysmal changes, and computed tomography angiography confirmed a true aneurysm of the second segment of the left subclavian artery and a pseudoaneurysm of the left axillary artery. Given the risk of rupture and limb ischemia, urgent surgical repair was performed through combined supraclavicular and axillary approaches. The subclavian aneurysm was resected, the axillary pseudoaneurysm evacuated, and both arteries reconstructed using an 8-mm × 15-cm polytetrafluoroethylene graft. The operation lasted 3 hours and 20 minutes. Distal perfusion was maintained via intermittent flushing with heparinized saline and controlled cross-clamping. Postoperative recovery was uneventful, and at 3 months, grafts remained patent with equal distal pulses bilaterally.

Simultaneous true subclavian and axillary artery pseudoaneurysms are exceptionally rare. Accurate diagnosis requires multimodal imaging, and management must be individualized based on anatomy, symptoms, and available resources.

Open surgical repair remains a safe and durable option for complex vascular lesions, particularly in low-resource settings where endovascular facilities are limited.