A modified supraclavicular approach for resection of a subclavian aneurysm

The incidence of right aneurysms of the innominate or subclavian arteries is not very high. The majority of these aneurysms is placed in the distal segment of subclavian arteries. These aneurysms are involved in the complex of the thoracic outlet compressive neurovascular syndrome, especially in occurrence of the cervical rib. All aneurysms in this region can rupture and embolize. This is the main purpose of surgical management of this clinical entity. The aim of this study is to refer an interesting case history of a relatively young patient with a right aneurysm of the middle portion of left subclavian artery. The patient had no known vascular risks and the aneurysm was asymptomatic, the only sign was the visible and palpable pulsating mass over the left clavicle. The aneurysms of the middle and central portion of the left subclavian artery are usually explored through the left high posterolateral thoracotomy. The authors refer their experience with the use of a modified technique of exposure--supraclavicular (or transclavicular) incision with the subperiostal resection of the medial portion of the clavicle. This approach affords excellent exposure and a safe surgical procedure. This approach has been described in 1988 by H. Machleder. The advantage of this approach is a diminished risk of surgery in comparison with the transthoracic approach. The authors suppose, however, that it can be useful in traumatic or occlusive lesions, as well.