Hybrid Treatment of an Intrathoracic Left Subclavian Artery Aneurysm

Abstract

The supraclavicular approach is difficult to use in direct surgery for intrathoracic subclavian artery aneurysms, and the best approach and procedure to use must be determined individually in each case. We successfully treated an intrathoracic left subclavian artery aneurysm in a patient with chronic obstructive pulmonary disease by combining bilateral axillary bypass surgery with endovascular treatment. A 66-year-old man underwent a chest X-ray during a regular health check-up that identified an abnormal shadow, and computed tomography showed an intrathoracic left subclavian artery aneurysm adjacent to the origin of the left subclavian artery. Because the patient had chronic obstructive pulmonary disease, he was not capable of tolerating direct surgery, and he requested that a less invasive surgical procedure be used. Bilateral axillary bypass surgery was first performed, after which the aneurysm was closed with an Amplatzer Vascular Plug II on the distal side and a thoracic stent graft on the proximal side, and the origin of the left subclavian artery between them was embolized. This less invasive procedure may be an effective method of treating intrathoracic left subclavian artery aneurysms in high-risk patients.