Subclavian aneurysms. Surgical and interventional therapeutic strategies

Aneurysms of the subclavian artery are extremely rare and most commonly cau sed by arteriosclerosis, trauma or thoracic outlet syndrome. Less frequentl y seen causes also include syphilis, cystic media necrosis or tuberculosis or congenital anomalies. The presence of a subclavian aneurysm can give ris e to various symptoms such as a pulsating supraclavicular mass, peripheral embolism or brachial plexus compression. Generally, surgical intervention i s undertaken involving ligation and extirpation of the aneurysm followed by interposition of either a saphenous vein- or synthetic vascular graft. Rec ent diversifications in potential therapeutic strategies include the clinic al application of transluminally positioned stents for the treatment of vas cular lesions. In the literature review we found more than 260 published ca ses of surgically treated subclavian aneurysms and addional 17 subclavian a neurysms treated by endoluminal stent application. From 1992-1997 5 subclav ian aneurysms were resected in our hospital. In four cases a vein graft of the vena saphena magna and in one case a PTFE graft were used. The sensory ischaemic deficit regressed in the further follow up in four of the five ca ses. Patency was checked postoperatively by ultrasound sonography, angiogra phy or MR-angiography.