The importance of management strategies for subclavian artery aneurysms (SAAs) is underscored by the risks of aneurysm rupture and distal ischemia. However, there is no consensus on the optimal timing or strategies for treatment due to their low incidence. The existing literature primarily comprises case reports and small retrospective studies, providing limited high-quality evidence. The preservation of the vertebral artery (VA) is critical to the prognosis of SAA repair, particularly when a dominant ipsilateral VA exists and the circle of Willis is incomplete. In this review, we integrate published literature together with our center’s experience to classify SAAs into four types based on the anatomical relationship between the VA and the aneurysm, and we outline the treatment strategies for each type. Furthermore, given the substantial influence of diverse etiologies on disease progression, we address the clinical features and management approaches for SAAs based on distinct etiologies.
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