Endovascular Management of Subclavian Artery Aneurysms

Subclavian artery aneurysms, whether true or pseudoaneurysms, pose significant risks including rupture, thromboembolism and distal embolisation. Historically managed by open surgical repair through sternotomy or supraclavicular approaches, recent decades have seen a shift towards minimally invasive endovascular solutions. Endovascular management encompasses covered stent graft deployment, coil embolisation and hybrid procedures combining open revascularisation with thoracic endovascular aneurysm repair (TEVAR). Patient selection hinges on aneurysm morphology, location relative to the vertebral and internal thoracic branches, and the status of proximal and distal landing zones. Pre-procedural planning involves high-resolution computed tomography angiography to assess neck angulation, vessel tortuosity and thrombus burden. Covered stents fashioned from nitinol-reinforced polytetrafluoroethylene achieve aneurysm exclusion while preserving branch perfusion, though attention must be paid to endoleak risk and long-term graft patency. Coil embolisation can be employed for saccular aneurysms with narrow necks or in pseudoaneurysm settings, often with adjunctive balloon-assisted techniques. Hybrid staged approaches, incorporating carotid–subclavian bypass or vertebral artery transposition prior to TEVAR, address situations in which the aneurysm neck encroaches on major branch origins. Overall, endovascular management offers reduced operative mortality, shorter hospital stay and rapid recovery, with procedural innovation continuously refining device delivery and anchoring strategies.

Research from Nature Portfolio

No recent Nature Portfolio content available.

Endovascular Management of Subclavian Artery Aneurysms publication trend

The graph below shows the total number of articles in endovascular management of subclavian artery aneurysms across all publications each year (not limited to Nature Index journals).

Technical terms

Covered stent graft: A tubular endovascular device combining a metallic scaffold and a fabric lining to exclude an aneurysm from blood flow.

Thoracic endovascular aneurysm repair (TEVAR): A minimally invasive procedure to treat thoracic aortic or branch aneurysms by deploying a stent graft within the vessel lumen.

Endoleak: Persistent blood flow into an excluded aneurysm sac following endovascular repair, classified by source and location.

Pull-through technique: A method employing a through-and-through guidewire between two vascular access points to stabilise devices in tortuous anatomy.

Carotid–subclavian bypass: A surgical graft connecting the common carotid artery to the subclavian artery to maintain limb and vertebrobasilar circulation during aneurysm exclusion.

References

1. Hybrid staged approach to subclavian artery aneurysm repair with aberrant dominant left vertebral artery. Journal of Surgical Case Reports (2023).
2. Endovascular Repair for Giant Right Subclavian Artery Aneurysm With Gore Viabahn and Pull-Through Procedure: A Case Report. Frontiers in Surgery (2022).