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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2005 August;18(4):167-72
Surgical repair of subclavian artery aneurysms: our experience
Irace L., Siani A., Faccenna F., Gabrielli R., Mastroddi M., Gossetti B., Benedetti-Valentini F.
Aim. True aneurysms of the subclavian artery are rare,and complications as rupture, thrombosis, embolization or clinical finding due to venous or neurological compression can occurre. Surgical repair is advised and related to the size of aneurysm and clinical symptoms. Aim of study is to evaluate diagnostic investigations, surgical management, and outcome of the patients operated.
Methods. From Jannuary 1995 to December 2002, 6 patients with 7 aneurysms of subclavian artery were reviewed. Three patients were asymptomatic, two patients , with bony abnormalities of thoracic outlet present fingers ischemic ulceration due to embolization. In one patient , with bilateral aneurysm , the clinical onset was rupture.All patients presented a pulsatile supraclavicular mass. Ultrasonography,Ctscan, angiography were performed il all patients. Through a supraclavicular and subclavicular incision,six aneurysms were treated by resection and graft replacement ( 5 PTFE , 1 ASV). In one case a transtoracic approach was performed and PTFE replacement carried out.
Results. No death or major complications occured at the early postoperative period and during the follow up (48 mounths).All the grafts were patent at clinical and Colorduplex scan examination.
Conclusion. Surgical treatment is advised for the natural history of these aneurysms. An accurate evaluation by Ctscan, ultrasonography, angiography is mandatory to confirm the diagnosis and planning the operation. Sopraclavicular and subclavicular combined aprroach is usefull in extrathoracic aneurysm. In case of intrathoracic aneurysms , a trans thoracic approach is raccomanded. Detension of the aneurismal sac is suggest to avoid nervous and venous impairament and graft compression. Best long term results are obtained in elective surgery and no difference occured with PTFE or ASV graft.