Subclavian artery aneurysm: an unusual manifestation of Takayasu's arteritis

Complications of Takayasu's arteritis are typically ischemic in nature beca use of progressive arterial narrowing, with aneurysm formation occurring as a late sequela. A 30-year-old Black woman with Takayasu's arteritis presen ted with a progressively enlarging and tender pulsatile mass at the base of the right neck, Upper extremity pulses were intact. Chest computed tomogra phy and aortography demonstrated a 6-cm aneurysm of the right subclavian ar tery, which originated at the takeoff from the innominate artery, which was also ectatic, There was no evidence of occlusive disease. An operation was performed via the median sternotomy with transverse extension into the sup raclavicular area. The distal innominate artery, proximal common carotid ar tery and entire subclavian artery were resected and replaced with a bifurca ted stretch ePTFE graft. The aneurysm was without thrombus or atheroscleros is and all vessels were extremely thick-walled. Pathology revealed healed/h ealing nonspecific arteritis, Aneurysm formation is an unusual complication of Takayasu's arteritis, Previously reported sites of aneurysm formation i nclude the thoracic and abdominal aorta, the innominate, carotid and superi or mesenteric arteries, but not the subclavian artery. Of 28 patients enrol led in a recent clinical protocol at the National Institutes of Health with Takayasu's arteritis, none had aneurysm formation. The authors report surg ical repair of a large aneurysm of the right subclavian artery in a young B lack woman with Takayasu's arteritis. (C) 1999 The International Society fo r Cardiovascular Surgery. Published by Elseiver Science Ltd. All rights res erved.