Abstract
A 71-year-old man was referred to our hospital for surgical treatment of a right subclavian artery aneurysm. The mass was 34 × 39 mm in size and was located approximately 12 mm distal to the bifurcation of the right common carotid artery and the right subclavian artery. Reversed L-shaped partial sternotomy was performed from the second intercostal space and the skin incision was extended to the superior border of the clavicle. Proximal clamping was performed between the right common carotid artery and the subclavian artery aneurysm. Distal clamping was performed at the first part of the axillary artery. The aneurysm was incised and backflow of the vertebral artery was observed from the lumen. Preoperative cranial MRA showed a communication between the right and left vertebral arteries, and the right vertebral artery was occluded from outside of the aneurysm. The aneurysm was replaced by an ePTFE graft (7 mm), and reconstruction was performed by end-to-side anastomosis of the right vertebral artery and the graft. Histological examination of the mass revealed an arteriosclerotic true aneurysm. An upper partial sternotomy approach was very useful for intrathoracic subclavian artery aneurysm because this approach provided a good operative field and enabled surgery without transection of the clavicle.
