c l i n i c a l f o l i o s : d i s c u s s i o n

Subclavian Artery Aneurysm



Related narrative: Subclavian Artery Aneurysm

The subclavian artery is the most common site of upper extremity aneurysm, although subclavian artery aneurysms are extremely rare when compared with other peripheral sites. Thoracic outlet syndrome is the most common cause of subclavian artery aneurysm. Other causes include atherosclerosis, trauma and infection. True aneurysms, those containing all vessel wall layers, as seen in this patient, are extremely rare. Subclavian artery aneurysms can be asymptomatic, but are usually associated with symptoms secondary to distal embolization and thrombosis. Patients can also present with symptoms of pressure from an enlarging pulsatile mass and, rarely, dysphagia or respiratory distress.

Signs of embolization include small painful punctile lesions affecting mostly fingers and the palm of the hand. In addition, patients may present with and audible bruit in the subclavian fossa or upper chest region. Ultrasound and CT scan can be used to establish a diagnosis, especially in the case of a palpable or pulsatile mass. MRI/MRA has been increasingly used to identify these lesions. Arteriography is currently the gold standard test, as it identifies the extent of vessel involved and demonstrates distal runoff. The imaging data is essential for planning a safe, successful surgical approach.

Most current literature and case reports state that surgical repair is indicated on the finding of a subclavian artery aneurysm. As with any surgical patient, the decision to operate should be weighed against the patient's general medical condition. Current literature reports excellent results in patients who undergo operative repair.

The basic vascular principle of proximal and distal control is essential in the repair of a subclavian artery aneurysm. It is important to removal any embolic source and rapidly reestablish arterial blood flow. Location and size of aneurysm are essential in deciding which surgical approach is most beneficial. A median sternotomy with extension into the supraclavicular fossa provides good exposure for control and repair of proximal subclavian aneurysm. Distal aneurysms can be approached through a supraclavicular approach. Due to the posterior position of the left subclavian artery origin from the aortic arch (see subclavian catheterization), left subclavian artery aneurysm requires a thoracotomy combined with supraclavicular incision for proper exposure and repair. If thoracic outlet syndrome is an etiologic factor, decompression of the superior thoracic aperture (see thoracic outlet syndrome) is necessary.

This page was last modified on 16-Jul-2002.