Dartevelle Approach for Intra-Thoracic Subclavian Artery Aneurysm Repair

Chris Bond, Jameel Muzaffar, Donald Adam, Ehab Bishay

Department of Cardiothoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, UK.
Department of Vascular Surgery, Heart of England NHS Foundation Trust, Birmingham, UK.

DOI: 10.4236/ojts.2014.42006                

Abstract

Subclavian artery aneurysm is a rare phenomenon in the West, but its prevalence is increasingly proportionate to incidence of atherosclerotic disease in the population. It is generally accepted that gold standard care is surgical resection but with limited experience opportunity remains to optimise this. We report on a 66-year-old female arteriopath with an 8 cm intra-thoracic aneurysm of the right subclavian artery, just distal to the brachiocephalic trunk. Lack of a proximal landing zone prohibited endovascular repair thus we utilised the anterior transcervical approach described by Dartevelle. This approach provided excellent visualisation of the aneurysm, along with right vagus and phrenic nerves, facilitating proximal and distal control and subsequent decompression. Post operative recovery was swift and not marred by substantial pain or inhibition of chest wall mechanics, associated with median sternotomy and thoracotomy incisions usually advocated for such aneurysms. As such we purport this approach to offer excellent operative exposure for this increasing disease burden, with less morbidity associated than the currently accepted approach, representing an advance in the management of this condition.

Keywords

Aneurysm, Subclavian Artery, Dartevelle Approach

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Dougherty, M.J., Calligaro, K.D., Savarese, R.P., et al. (1995) Atherosclerotic Aneurysm of the Intrathoracic Subclavian Artery: A Case Report and Review of the Literature. Journal of Vascular Surgery, 21, 521-529. http://dx.doi.org/10.1016/S0741-5214(95)70297-0
[2]	Witz, M., Yahel, J. and Lehmann, J.M. (1998) Subclavian Artery Aneurysms. A Report of 2 Cases and a Review of the Literature. The Journal of Cardiovascular Surgery, 39, 429-432.
[3]	Dartevelle, P.G., Chapelier, A.R., Macchiarini, P., et al. (1993) Anterior Transcervical-Thoracic Approach for Radical Resection of Lung Tumors Invading the Thoracic Inlet. The Journal of Thoracic and Cardiovascular Surgery, 105, 1025-1034.
[4]	Lawrence, P.F., Gazak, C., Bhirangi, L., et al. (1999) The Epidemiology of Surgically Repaired Aneurysms in the United States. Journal of Vascular Surgery, 30, 632-640. http://dx.doi.org/10.1016/S0741-5214(99)70102-3
[5]	Van Leemput, A., Maleux, G., Heye, S., et al. (2007) Combined Open and Endovascular Repair of a True Right Subclavian Artery Aneurysm without Proximal Neck. Interactive Cardiovascular Thoracic Surgery, 6, 406-408. http://dx.doi.org/10.1510/icvts.2006.149088