Surgical treatment of posttraumatic pseudo-aneurysm of right subclavian artery

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Justine Malvaux (1), Asmae Belhaj (2), Philippe Eucher (3) Published in the journal : September 2021 Category : Clinical Report

Summary :

Right proximal subclavian artery traumatism is rare, but it may be associated with pseudo-aneurysm formation. Currently, its treatment consists of an endovascular procedure using covered stenting. Indeed, open surgery can be quite challenging due to the subclavian artery’s anatomical; therefore, such an intervention is associated with a high morbidity and mortality rate. We report the case of a 71-year-old man presenting with a right proximal subclavian artery pseudo-aneurysm following a car injury having occurred 11 years prior. Several endovascular procedures were performed, but they all failed to exclude the aneurysm. This report sought to demonstrate that an open surgical approach is still possible following failure of less invasive interventions. A right aorto-carotido-subclavian bypass was carried out using an approach combining a median sternotomy and right cervicotomy. The patient’s postoperative course was uneventful. The first follow-up at 6 weeks post-intervention confirmed both the exclusion of the pseudo-aneurysm and vascular permeability. Yet, the 1-year-follow-up is mandatory to confirm this favorable outcome.

What is already known about the topic?

Subclavian artery pseudo-aneurysms are rare. The endovascular approach is considered to be the first-line treatment, given that open surgery is a complex procedure due to to anatomical features, being associated with significant morbidity and mortality.

What does this article bring up for us?

If endovascular procedures do not succeed, pseudo-aneurysm exclusion with vascular permeability preservation of main arterial trunks can be achieved using open bypass surgery.

Key Words

Subclavian artery, pseudo-aneurysm, surgery