Hybrid Treatment of the Intrathoracic Right Subclavian Artery Aneurysm / 日本心臓血管外科学会雑誌

Subclavian artery aneurysm (SCAA), a peripheral arterial aneurysm, is a rare entity. The surgical procedure and approach depend on the location of the aneurysm. We present a case of the endovascular therapy combined with cross axillary bypass. The patient was a 75-year-old man with a small abdominal aortic aneurysm. Multi-detector computed tomography (MDCT) revealed an intrathoracic right SCAA 38 mm in diameter. The operation was performed successfully under general anesthesia. After cross bypass of bilateral axillary artery, the orifice of the right subclavian artery was covered with a stent-graft inserted into the right common carotid artery-brachiocephalic artery and the right subclavian artery was occluded with coils distal to the aneurysm. Post operation angiogram showed complete exclusion of the SCAA and patency of the right common carotid and right vertebral artery. We thought this hybrid treatment for the intrathoracic SCAA could be a useful surgical strategy.

Giant Subclavian Artery Aneurysm Associated with Airway Stenosis / 日本心臓血管外科学会雑誌

A 65-year-old man presented to our hospital with a chief complaint of hoarseness. Chest radiography and computed tomography detected a right subclavian artery aneurysm. The aneurysm had a maximum diameter of 85 mm, and was associated with a mural thrombus and displacement of the trachea to the left, which led to airway stenosis. In case ventilatory insufficiency developed during anesthesia induction, an extracorporeal membrane oxygenator was prepared, followed by administration of anesthesia. Careful administration of anesthesia allowed for anesthesia management without the extracorporeal membrane oxygenator. We approached the periphery and the proximal portion of the aneurysm through a right subclavicular incision and partial median sternotomy, respectively. After excision of the aneurysm, we performed EPTFE prosthesis implantation. The patient's postoperative course was uneventful, which led to postoperative improvement of the airway stenosis. The combination of a right subclavicular incision and partial median sternotomy is useful for the surgical treatment of large subclavian artery aneurysms such as the one in this case. Moreover, careful anesthesia management after close consultation with anesthesiologists is important for patients who exhibit preoperative airway stenosis.