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International Society For Minimally Invasive Cardiothoracic Surgery

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Endovascular Closure of Right Subclavian Artery Aneurysm
Rafael Garcia-Borbolla Fernández, Bella Ramirez González, Mariano Garcia-Borbolla Fernández, Enrique Perez Duarte
Hospital Infanta Luisa, Sevilla, Spain

BACKGROUND: Axillary artery aneurysm is the rarest peripheral artery aneurysm. Are mostly originate from trauma, mycotic lesions, thoracic outlet syndrome, previous arteriovenous fistulae and atherosclerosis. Most of them are asymptomatic. They can be diagnosed by simple physical examination as a pulsatile mass.
METHODS: A 47 year-old woman was admitted after study for casual pulsatile mass in the neck. She had a past medical history significant for cutaneous angioma in right supraclavicular region that was operated in the childhood with cauterization. In our physical examination, we found an about 6×3cm solid, palpable pulsating mass in the right supraclavivular fossa. A computed tomography (CT) angiography revealed a 62.5 × 30.3 mm size true aneurysm of the right axillary artery distal to the origin of right mamarian artery.
RESULTS: We planned to adopt a less invasive approach. Under local anesthesia, percutaneous access was obtained through the right groin and a 8-French sheath was introduced through the side. A self-expanding endoluminal endoprosthesis with ePTFE and nitinol (9 x 100 mm) was deployed successfully. Postprocedure angio revealed optimal device positioning, with complete exclusion of the aneurysm and without obstruction of the right common carotid artery and right mamarian artery. There were no adverse peri-operative events, including ischemic symptoms of the right arm. CT scan in the follow up showed a complete resolution of the aneurysm without endoleaks. After 3 years of follow up no further complications were related.
CONCLUSIONS: Axillary artery aneurysm is a rare disorder. Endovascular management is an evolving option with higher technical success rate and lower mortality and morbidity rates than open surgery when is performed by an experienced endovascular surgeon. In addition, it is an effective and safe therapeutic approach.LEGEND: Left Angiography pre and post procedure. Right: CT scan pre and post.


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