Utility of Preoperative 3D CT Angiography and Proximal Balloon Occlusion to Minimize Morbidity of Open Repair of a True Subclavian Artery Aneurysm

This report highlights the utility of three dimensional (3D)-CT angiography, in conjunction with combined endovascular and open surgical management, to treat a degenerative subclavian artery aneurysm. The patient presented with an incidentally discovered right subclavian artery aneurysm and underwent surgical reconstruction without complication. Although a variety of case reports in the literature document repair of various subclavian artery pathologies including those associated with aberrant subclavian artery anatomy (Kommerel's diverticulum), iatrogenic pseudoaneurysm, and thoracic outlet compression with post-stenotic dilatation, post-inflammatory and infectious aneurysms; true fusiform degenerative aneurysms of the subclavian artery remain a rare clinical entity. These lesions present with variable anatomic configurations, which can be clearly defined with pre-operative CT or MR angiography. Defining the anatomy with 3D imaging can facilitate clinical decisionmaking and allow potential application of hybrid approaches to surgical management.