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 PS16. Intra-thoracic Subclavian Artery Aneurysm Repair in the Thoracic Endovascular Era

​Michael E. Barfield, Nicholas D. Andersen, Asad A. Shah, Cynthia K. Shortell, Richard L. McCann, G. Chad Hughes
Duke University Medical Center, Durham, NC.

OBJECTIVES: Intra-thoracic subclavian artery aneurysms (SAAs) are rare aneurysms that often occur in association with concomitant aortic pathology. Modern thoracic endovascular aortic repair (TEVAR) methods may complement or replace conventional open SAA repair.

METHODS: A retrospective review was performed of all intra-thoracic SAAs repaired at a single institution since the FDA approval of TEVAR in 2005.

RESULTS: Nineteen patients underwent 20 operations to repair 22 (13 native, 9 aberrant) SAAs with an intra-thoracic component (Table). Mean SAA diameter was 3.1 cm (range 1.6-6.0 cm). Median patient age was 62 years (range 24-80 years). Four patients (21%) had a connective tissue disorder (two Loeys-Dietz, two Marfan). Overall, 8 (36%) SAAs were repaired by open techniques and 14 (64%) via a TEVAR-based approach. All TEVAR cases required proximal landing zone in the aortic arch and revascularization of at least one arch vessel in 11 patients (79%). Concomitant repair of associated aortic pathology was performed in 10 patients with 12 (55%) subclavian aneurysms. Thirty-day/in-hospital rates of death, stroke, and permanent paraplegia/paresis were 5% (n=1), 5% (n=1), and 0%, respectively. Three (16%) patients required delayed re-intervention, two for occluded bypass grafts and one for type II endoleak at a mean follow-up of 28+/-23 months.

CONCLUSIONS: This is the largest single-institution series to date of intra-thoracic SAA repair, as well as the largest series of aberrant SAA repair. Modern endovascular techniques expand SAA repair options with excellent results. The majority of SAAs, and nearly all aberrant SAAs, can now be repaired using a TEVAR-based approach without the need for sternotomy or thoracotomy.

AUTHOR DISCLOSURES: N. D. Andersen, Nothing to disclose; M. E. Barfield, Nothing to disclose; G. Hughes, W.L. Gore and Associates, Research Grants, W.L. Gore and Associates, Consulting fees or other remuneration (payment),  W.L. Gore and Associates, Speaker’s bureau Medtronic Vascular, Consulting fees or other remuneration (payment), Medtronic Vascular, Speaker’s bureau, Vascutek Terumo, Consulting fees or other remuneration (payment), Vascutek Terumo, Speaker’s bureau; R. L. McCann, Nothing to disclose; A. A. Shah, Nothing to disclose; C. K. Shortell, Nothing to disclose.

SAA Location
N
Open Repair
Endovascular Repair
Symptomatic
Concomitant Aortic Repair
Native left
11
6 (55%)
5 (45%)
3 (27%)
7 (64%)
Native right
2
2 (100%)
0
1 (50%)
1 (50%)
Aberrant left
2
0
2 (100%)
2 (100%)
0
Aberrant right
7
0
7 (100%)
3 (43%)
4 (57%)
Total
22
8 (36%)
14 (64%)
9 (41%)
12 (55%)

Posted April 2012

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VascularWeb® is the prime source for all vascular health and disease information, and is presented by the Society for Vascular Surgery®. Its members are vascular surgeons, specialists, and vascular health professionals who are specialty-trained in all treatments for vascular disease including medical management, non-invasive procedures, and surgery.