Zha Binshan, Chen Zhiyong, Ou-Yang Huan
Department of Vascular and Thyroid Surgery, Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
Front Surg. 2022 Jul 5;9:939818. doi: 10.3389/fsurg.2022.939818. eCollection 2022.
Giant true subclavian artery aneurysms (SAAs) (>5 cm) are rare. Technical and anatomical considerations complicate the endovascular treatment of SAAs and pose some challenges. Here, we present a giant right SAA that was successfully excluded using stent grafts with the pull-through technique after two interventional steps and discuss the pull-through technique details as well as the lessons to be learned from this case.
A 50-year-old man presented at our department complaining of dyspnea and hoarseness. Computed tomography angiography (CTA) showed a giant right SAA with partial intraluminal thrombus and severe angulated aneurysm necks originating from the proximal right subclavian artery, approximately 70 × 71 mm in size.
An 8 × 100-mm Gore Viabahn was selected to exclude the SAA. A decision was made to stabilize the wire tension using the pull-through technique. Final angiography showed that the SAA was essentially excluded, and slight endoleak was observed. At 6 months, imaging showed that the aneurysm was not obviously shrinking, there was still an endoleak and stent graft dislodgement was observed. Angiography confirmed a type Ia endoleak, which was managed by the placement of a 10 × 50-mm Gore Viabahn, again with the assistance of the pull-through technique. At the 25-month follow-up, CTA showed that the SAA was satisfactorily excluded, with no endoleak, and the SAA was reduced in size.
Endovascular treatment of SAAs is a safe, reliable and minimally invasive approach. The pull-through technique may improve wire tension and device stabilization. Additionally, size selection and positioning should be reappraised under a severely angulated aneurysm neck.
巨大的真性锁骨下动脉瘤（SAA，直径>5 cm）较为罕见。技术和解剖学因素使SAA的血管内治疗变得复杂，并带来了一些挑战。在此，我们介绍一例巨大的右侧SAA，经两个介入步骤后，采用带膜支架经拖拉技术成功将其隔绝，并讨论拖拉技术细节以及从此病例中吸取的经验教训。
一名50岁男性因呼吸困难和声音嘶哑就诊于我科。计算机断层扫描血管造影（CTA）显示一个巨大的右侧SAA，腔内有部分血栓，动脉瘤颈部严重成角，起源于右侧锁骨下动脉近端，大小约为70×71 mm。
选择一枚8×100-mm的戈尔Viabahn支架来隔绝该SAA。决定采用拖拉技术稳定导丝张力。最终血管造影显示SAA基本被隔绝，观察到轻微内漏。6个月时，影像学检查显示动脉瘤没有明显缩小，仍有内漏，且观察到支架移位。血管造影证实为Ia型内漏，再次采用拖拉技术辅助，置入一枚10×50-mm的戈尔Viabahn支架进行处理。在25个月的随访中，CTA显示SAA被满意地隔绝，无内漏，且SAA体积缩小。
SAA的血管内治疗是一种安全、可靠且微创的方法。拖拉技术可改善导丝张力和器械稳定性。此外，在严重成角的动脉瘤颈部情况下，应重新评估尺寸选择和定位。
