CASE REPORTS  VASCULAR PAPERS 

The Journal of Cardiovascular Surgery 2000 June;41(3):463-7

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Transcatheter embolization of mycotic aneurysm of the subclavian artery with metallic coils

Mori K., Saida Y., Kuramoto K., Anno I., Yoshioka H., Irie T., Itai Y.

From the Department of Radiology Tsukuba University Hospital, Tsukuba, Japan *Department of Radiology National Hospital Tokyo Disaster Medical Center Tachikawa, Japan

Mycotic aneu­rysms of the sub­cla­vian ­artery are ­rare. This ­report ­describes an expe­ri­ence of 2 ­rare cas­es in ­which trans­cath­et­er embol­iza­tion ­with metal­lic ­coils was per­formed for the man­age­ment of ­these ­lesions alter­na­tive to sur­gery.
Two ­patients who had ­been treat­ed ­with chem­o­ther­a­py for malig­nant neo­plasms ­were diag­nosed as hav­ing mycot­ic aneu­rysms of the ­left sub­cla­vian ­artery. The caus­es of ­these ­lesions ­were pre­sumed to be the inva­sion of the arte­ri­al ­wall by the pul­mo­nary ­abscess in ­case 1, and ­wound infec­tion ­after place­ment of the res­er­voir for intra­ar­te­ri­al chem­o­ther­a­py in ­case 2. In ­both cas­es, prox­i­mal and dis­tal ­sites of the aneu­rysm ­were embol­ized ­with metal­lic ­coils. In ­case 1, the ver­te­bral ­artery was ­also embol­ized ­with Guglielmi detach­able ­coils to ­avoid ret­ro­grade ­blood ­flow.
Both aneu­rysms ­were com­plete­ly occlud­ed by a sin­gle embol­iza­tion. In ­case 1, ­although weak­ness and pares­the­sia of the ­left ­hand ­remained, ­lethal hemop­ty­sis due to aneu­rys­mal fis­tul­iza­tion to the ­lung paren­chy­ma ­ceased. In ­case 2, no neu­ro­log­i­cal def­i­cit ­except for ­mild pares­the­sia in the ­left ­thumb had ­been ­observed. Both ­patients ­died of pri­mary ­disease 10 and 5 ­months ­after the pro­ce­dure.
Transcatheter embol­iza­tion is tech­ni­cal­ly fea­sible and effec­tive ­enough to ­treat the mycot­ic aneu­rysm of the sub­cla­vian ­artery ­even in the sit­u­a­tion in ­which the sur­gi­cal ­option ­seems to be dif­fi­cult or ­risky.