Endovascular Reconstruction of Subclavian Artery Aneurysms in Patients with Arterial Thoracic Outlet Syndrome

Background: Subclavian artery aneurysms associated with thoracic outlet syndrome (TOS) have traditionally been managed by open surgical reconstruction. Endovascular subclavian artery reconstruction is novel in the setting of arterial TOS (aTOS). Our objective is to report our results with endovascular subclavian artery reconstruction in aTOS patients over a 10-year period with attention to surgical approach and late results. Methods: Patients who underwent stent-graft reconstruction of subclavian artery aneurysms associated with aTOS between 2006 and 2016 were identified in a prospective database. Data collected included age, gender, presentation, surgical details, and outcomes. Results: Over the study period, 869 TOS procedures were performed. Of these, 7 (0.8%) were aTOS related subclavian artery aneurysms managed with stent-graft repair. All presented with upper extremity pain (7) and a majority with limb-threatening ischemia (6). Other significant findings included subclavian artery aneurysm (7), cervical rib (4), and clavicular fracture (3). TOS decompression was accomplished via transaxillary cervical and first rib resection. Stent-graft deployment was performed concurrently with TOS decompression via brachial artery approach. The mean follow-up period was 24.9 months (range 1-60). Two patients required reintervention for stent thrombosis (1.5 months, 36 months) and 1 required balloon angioplasty for in-stent restenosis (24 months). Limb salvage was achieved in all patients with no major amputations, no minor amputations, and restoration of normal function in all. Conclusions: Our experience indicates that stent-graft reconstruction of subclavian artery aneurysms associated with aTOS is successful. This procedure was characterized by short surgical times, low blood loss, and no complications. It may be subject to late graft thrombosis or stenosis and requires life-long surveillance.