Abstract
Subclavian artery aneurysm is a rare phenomenon in the West, but its prevalence is increasingly proportionate to incidence of atherosclerotic disease in the population. It is generally accepted that gold standard care is surgical resection but with limited experience opportunity remains to optimise this. We report on a 66-year-old female arteriopath with an 8 cm intra-thoracic aneurysm of the right subclavian artery, just distal to the brachiocephalic trunk. Lack of a proximal landing zone prohibited endovascular repair thus we utilised the anterior transcervical approach described by Dartevelle. This approach provided excellent visualisation of the aneurysm, along with right vagus and phrenic nerves, facilitating proximal and distal control and subsequent decompression. Post operative recovery was swift and not marred by substantial pain or inhibition of chest wall mechanics, associated with median sternotomy and thoracotomy incisions usually advocated for such aneurysms. As such we purport this approach to offer excellent operative exposure for this increasing disease burden, with less morbidity associated than the currently accepted approach, representing an advance in the management of this condition.
Highlights
Subclavian Artery Aneurysm (ScAAn) is a rare phenomenon with incidence in Western populations ~1/100,000 per annum, comprising only 0.5% of diagnosed aneurysmal disease
ScAAn is classified based upon anatomical location which generally reflects aetiology
We report a 66-year-old known arteriopath who presented with a 2 month history of right upper limb pain following a minor fall
Summary
Subclavian Artery Aneurysm (ScAAn) is a rare phenomenon with incidence in Western populations ~1/100,000 per annum, comprising only 0.5% of diagnosed aneurysmal disease. Mean age of incidence is 49 years, twice as common in males. ScAAn is classified based upon anatomical location which generally reflects aetiology. How to cite this paper: Bond, C., et al (2014) Dartevelle Approach for Intra-Thoracic Subclavian Artery Aneurysm Repair. Intra-thoracic ScAAn is most often due to atherosclerosis, and it is most frequent in males > 60 years. Remaining aetiologies include inflammatory processes, Marfan’s disease, cystic medial necrosis and congenital abnormality, and these have no preponderance for either anatomical location [1]. The consensus that operative management is gold standard therapy is based upon extrapolation from other aneurysmal disease. The optimal approach to operative management is not established
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