Successful Endovascular Treatment of an Intrathoracic Left Subclavian Artery Aneurysm with TEVAR and Coil Embolism

(Department of Cardiovascular Surgery, Yao Tokushukai General Hospital, Osaka, Japan, and Department of Radiology, Matsubara Tokushukai Hospital*, Osaka, Japan)

Haruhiko Akagi Hiroshi Irie Yoshihisa Nakao
Kei Sakai Shoji Sakaguchi*
A 77-year-old man with an abdominal aortic aneurysm, detected by abdominal ultrasonography, was referred to our hospital. Multi-detector computed tomography(MDCT)revealed an intrathoracic left subclavian artery aneurysm 30mm in diameter and a small distal arch aortic aneurysm as well as an abdominal aortic aneurysm 40mm in diameter. Surgery was indicated for the subclavian artery aneurysm considering the risks of rupture and distal embolism. Our choice for treatment was endovascular repair;thoracic endovascular aortic repair(TEVAR)and coil embolism. The operation was performed successfully. Orifices of the left subclavian artery and the distal arch aneurysm were covered with a stent graft and the left subclavian artery was occluded with coils distal to the aneurysm. The operation time was 1 h and 44 min. He was extubated in the operation theater. A follow-up CT scan performed at 1 week showed the correct position of the TEVAR device, patency of the common trunk of the brachiocephalic and right common carotid arteries, and complete exclusion of the aneurysms. He was discharged on the 12th postoperative day without complication. Subclavian artery aneurysms, in particular in the intrathoracic location, are rare. Conventional surgery for this entity tends to require arch replacement to be unreasonably invasive as a therapy for peripheral artery disease. We believe this endovascular therapy can be a useful, less-invasive alternative to conventional open surgery.
  Jpn. J. Cardiovasc. Surg. 42:215-218(2013)

Keywords:intra thoracic subclavian artery aneurysm, TEVAR, coil embolism