A 38-Year-Old Man With Marfan Syndrome and Bilateral Subclavian Artery Aneurysms

Abstract

A 38-year-old man with Marfan syndrome, with a history of aortic dissection and aneurysmal degeneration that had been previously repaired with a valve-sparing ascending aortic replacement and a thoracoabdominal aorta repair from the ascending repair through the common iliac arteries with renal and mesenteric debranching, presented for asymptomatic bilateral subclavian artery aneurysms found on surveillance imaging. He had a 4-cm aneurysm on the right and a 2-cm aneurysm on the left. He had been lost to follow-up for 5 years. Because of his median sternotomy and his severe pectus excavatum, we thought that a staged cervical hybrid repair was best. He underwent a right subclavian artery repair with reimplantation of the right vertebral artery onto the common carotid and a carotid-subclavian bypass, along with a retrograde exclusion of the right subclavian artery origin with a Gore Excluder (W. L. Gore & Associates, Flagstaff, Ariz). One month later, he developed acute chest and shoulder pain associated with a dissection and enlargement (2 cm to 2.3 cm in 6 weeks) of his left subclavian artery aneurysm. He was subsequently taken for repair of the left subclavian artery by left common carotid to axillary artery bypass, reimplantation of the left vertebral artery onto the left common carotid, and Amplatzer plug occlusion of the prior arch branch to the left subclavian. Postoperatively, the patient did develop a minor hospital-acquired pneumonia that resolved with antibiotics and aggressive pulmonary hygiene. Subclavian artery aneurysms are rarely associated with Marfan syndrome. We review different approaches to subclavian artery aneurysms.