Chonnam Med J.  2014 Aug;50(2):70-73. 10.4068/cmj.2014.50.2.70.

Successful Treatment of a Ruptured Subclavian Artery Aneurysm Presenting as Hemoptysis with a Covered Stent

• Kim SS
• Jeong MH
• Kim JE
• Yim YR
• Park HJ
• Lee SH
• Rhew SH
• Jeong YW
• Kim JH
• Cho JG
• Park JC

• KMID: 2172163
• DOI: http://doi.org/10.4068/cmj.2014.50.2.70

Abstract

An aneurysm of the subclavian artery is rare. Recently, we experienced a case of a ruptured subclavian artery aneurysm presenting as hemoptysis. The patient had experienced atypical chest discomfort, and computed tomography (CT) revealed a small aneurysm of the left subclavian artery (SCA). Hemoptysis occurred 2 weeks later. Follow-up CT showed a ruptured aneurysm at the proximal left SCA. Endovascular treatment with a graft stent was performed by bilateral arterial access with a 12-Fr introducer sheath placed via cutdown of the left axillary artery and an 8-Fr sheath in the right femoral artery. A self-expandable Viabahn covered stent measuring 13x5 mm was introduced retrogradely via the left axillary sheath and was positioned under contrast guidance with an 8-Fr JR4 guide through the femoral sheath. After the procedure, hemoptysis was not found, and the 3-month follow-up CT showed luminal patency of the left proximal SCA and considerable reduction of the hematoma.

Keyword

Aneurysm; Stents; Subclavian artery

MeSH Terms

Aneurysm*
Aneurysm, Ruptured
Axillary Artery
Femoral Artery
Follow-Up Studies
Hematoma
Hemoptysis*
Humans
Phenobarbital
Stents*
Subclavian Artery*
Thorax
Transplants
Phenobarbital

Figure

• 

  FIG. 1 (A) Chest computed tomography angiogram (CTA) showed a small aneurysm of the proximal left subclavian artery. (B) Follow-up chest CTA showed 7 cm of loculated fluid collection with peripheral wall enhancement in the upper hemithorax and an irregular contrast filling sac of about 2.5 cm.

• 

  FIG. 2 Neck computed tomography angiogram showed an irregular contrast filling sac of 2.5 cm arising from the left proximal subclavian artery with scattered vascular calcifications.

• 

  FIG. 3 (A) Angiogram using a pigtail catheter via a right femoral approach was performed to delineate the anatomy and confirmed the aneurysmal leakage. (B) A self-expandable Viabahn covered stent (W.L. Gore and Associates Inc. U.S.A.) measuring 13×5 mm was introduced over the stiff wire in the subclavian artery retrogradely via the left axillary sheath. (C) The stent graft was deployed over the stiff wire in the subclavian artery under fluoroscopic guidance. (D) Minimal contrast leakage remained in the aneurysm but the flow was very slow.

• 

  FIG. 4 Three months later, follow-up chest computed tomography angiogram showed luminal patency of the left proximal subclavian artery and considerable reduction of the hematoma.

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