Elsevier

Journal of Vascular Surgery

Volume 18, Issue 6, December 1993, Pages 1056-1059
Journal of Vascular Surgery

Case Reports
Transluminal placement of a prosthetic graft-stent device for treatment of subclavian artery aneurysm*

https://doi.org/10.1016/0741-5214(93)90562-ZGet rights and content

Abstract

A 78-year-old man was seen with an expanding 5 cm false aneurysm of the right subclavian artery. This was treated by an intraluminal graft-stent device introduced through the brachial artery via a 16 F sheath. The graft was constructed from two polytetrafluoroethylene patches of 0.4 mm thickness and anchored in the subclavian artery by an 8 mm stainless steel stent. The procedure was monitored by an image intensifier. Completion arteriography and postoperative duplex scanning confirmed normal flow through the subclavian artery with no communication between the lumen and the aneurysmal sac. The patient recovered without complication. (J VASC SURG 1993;18:1056-9.)

Section snippets

Case report

A 78-year-old male patient required total parenteral nutrition because of pyloric obstruction. The initial attempt to gain vascular access for total parenteral nutrition was via the right subclavian vein. This was unsuccessful. A subsequent attempt to place a line in the left subclavian vein was successful. One week later it was noted that an expansile pulsation was present in the right supraclavicular fossa. A decision was made to keep the patient under observation rather than operate on the

Discussion

The treatment options for this patient were conservative observation, open operation, or endovascular repair. Conservative management involved considerable risk in view of the size of the aneurysm, its observed increase in size, and the geographic isolation of the patient from a specialized vascular service. Open operation on the subclavian artery may be approached through a supraclavicular incision or by thoracotomy. In this case, control of the proximal subclavian artery could be obtained

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*

Reprint requests: Professor James May, Department of Surgery, University of Sydney, NSW 2006 Australia.

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