Advances in Management of Subclavian Artery Aneurysms

Joseph J. Ricotta II, M.D., Thomas C. Bower, M.D., Timucin Taner, M.D., Barbara J. Toomey, R.N., Janet M. Hofer, R.N., Audra A. Duncan, M.D., Peter Gloviczki, M.D.
Mayo Clinic, Rochester, MN, USA.

Objective: To determine complications and outcome of open repair (OR) and endovascular repair (EVAR) of subclavian artery aneurysms (SAA).
Methods: Retrospective review of clinical data of patients treated for SAA at our institution between 1990 and 2005.
Results: Forty-nine patients, 32 males, 17 females (mean age 54 years) underwent treatment for SAA (mean size 3.1 cm, range: 1.25 to 7.0 cm). Thirty-eight patients had true and 11 patients had false aneurysms. Etiology was atherosclerosis (35%), thoracic outlet syndrome (30%), trauma (17%), and connective tissue disease (11%). Symptoms (55%) included upper extremity pain, exertional fatigue, and paresthesia. Seven patients (15%) had distal thromboembolism and five (10%) had cerebral embolism. Pulsatile neck mass or bruit was present in 18 patients, 15 had diminished or absent arm pulses. Concomitant aneurysms were present in 14 patients (30%), most commonly involving the thoracic or abdominal aorta. Forty-four patients underwent OR, using interposition graft (25) or bypass (19). Fifteen patients had concurrent 1st or cervical rib resection. Five patients underwent EVAR using covered stents. There were no operative deaths. Four patients had early complications after OR (wound infection, 1, respiratory insufficiency, 2, and nerve injury, 1), none after EVAR. Average follow-up was 7.25 years for OR, and 1 year for EVAR. There was no late limb loss, graft or stent occlusion, or death related to SAA.
Conclusion: Thromboembolic complications of SAA are ominous. Repair of SAA can be performed effectively with both OR and EVAR, with a low rate of complications and excellent outcome.

Back to Annual Meeting
Back to Program