Giant isolated aneurysm of the proximal right subclavian artery: A case report and surgical implications

Giant isolated proximal subclavian artery (SCA) aneurysm is an extremely rare disease. In most cases the true subclavian artery aneurysms are of atherosclerotic origin. These aneurysms are often revealed by complications such as thromboembolism, upper extremity ischemia, or rupture, and their surgical treatment is always indicated. We report a case of a 54-year-old woman, with an intrathoracic true aneurysm of the right SCA.The patient was a 54-year-old woman who presented with back pain without previous history of trauma. She had also diabetes mellitus, arterial hypertension, and undiagnosed left diaphragmatic eventration. The aneurysm was characterized by the presence of a short proximal neck, and involvement of the origin of the right vertebral artery (Figure 1 A, B). Due to the presence of a short proximal neck, and for its big size, we decided to approach the aneurysm through a median sternotomy with right cervical extension. After proximal and distal control of the aneurysm, it was excised and performed a direct subclavian–subclavian interposition grafting with end-to-end anastomoses using an 8 mm expanded polytetrafluoroethylene (ePTFE) graft (Figure 1 C, D). Good pulsation was achieved in all distal arteries. The histology defined an atherosclerotic aneurysm. Open surgical repair is the standard treatment modality of SCA aneurysms, but when located in the intrathoracic segment, it necessitates an invasive approach with sternotomy or lateral thoracotomy. Surgical repair of huge proximal right SCA aneurysms can be difficult. They typically require a combined mediastinal exposure to control the innominate and right common carotid arteries and a supra- or infraclavicular exposure for distal control, with either a segmental resection and bypass or a bifurcated reconstruction. We conclude that conventional “open” surgery remains effective for complex vascular diseases even in the era of advanced “endovascular” surgeries