Sage Journals: Discover world-class research

Abstract

Purpose:

To report successful stent-graft treatment of a mycotic pseudoaneurysm of the left subclavian artery in an immunosuppressed patient.

Case Report:

A 17-year-old immunosuppressed woman undergoing treatment for recurrent leukemia developed persistent fever and 2 episodes of hemoptysis. A contrast-enhanced computed tomographic (CT) scan demonstrated a saccular aneurysm of the left subclavian artery, which was considered to be a mycotic aneurysm caused by erosive fungal infection from the lung. The pseudoaneurysm was treated with a homemade stent-graft consisting of a nitinol stent and a polyester fabric. A type II endoleak present at the end of the procedure appeared to have sealed spontaneously on the CT scan at 3 days. No neurological deficit or ischemic symptoms of the left arm were noted during the follow-up, which lasted until the patient died 11 months later after rejecting a second bone marrow transplant.

Conclusions:

Endovascular repair may be an alternative to open surgery for the management of mycotic aneurysms of the subclavian artery.

Keywords

subclavian artery pseudoaneurysm leukemia hemoptysis fungal infection custom-made stent-graft nitinol stent

Get full access to this article

View all access options for this article.

References

Boundy

Bignold

. Syphilitic aneurysm of the right subclavian artery presenting with hemoptysis. Aust N Z J Med. 1987;17:533–535.

Muller

Wegener

Grabitz

. Mycotic aneurysms of the thoracic and abdominal aorta and iliac arteries: experience with anatomic and extra-anatomic repair in 33 cases. J Vasc Surg. 2001;33:106–113.

Semba

Sakai

Slonim

. Mycotic aneurysms of the thoracic aorta: repair with use of endovascular stent-grafts. J Vasc Interv Radiol. 1998;9:33–40.

Schneider

Abcarian

Leduc

. Stent-graft repair of mycotic superficial femoral artery aneurysm using a Palmaz stent and autologous saphenous vein. Ann Vasc Surg. 1998;12:282–285.

Madhavan

McDonnell

Dowd

. Suprarenal mycotic aneurysm exclusion using a stent with a partial autologous covering. J Endovasc Ther. 2000;7:404–409.

Kinney

Kaebnick

Mitchell

. Repair of mycotic paravisceral aneurysm with a fenestrated stent-graft. J Endovasc Ther. 2000;7:192–197.

Maruyama

Ishiguchi

Kato

. Stent-graft placement for pseudoaneurysm of the aorta. Radiat Med. 2000;18:177–185.

Ishida

Kato

Hirano

. Limitations of endovascular treatment with stent-grafts for active mycotic thoracic aortic aneurysm. Cardiovasc Intervent Radiol. 2002;25:216–218.

Berchtold

Eibl

Seelig

. Endovascular treatment and complete regression of an infected abdominal aortic aneurysm. J Endovasc Ther. 2002;9:543–548.

10.

Kwon

Choi

. Percutaneous stent-graft repair of mycotic common femoral artery aneurysm. J Endovasc Ther. 2002;9:690–693.

11.

Sanada

Matsui

Terayama

. Early clinical experience with a newly developed nitinol stent-graft for endovascular repair of aortic aneurysms [abstract]. Cardiovasc Intervent Radiol. 2000;23(Suppl 1):S144.

12.

Sanada

Matsui

Terayama

. Clinical application of a curved nitinol stent-graft for thoracic aortic aneurysms. J Endovasc Ther. 2003;10:000–000.

13.

Saliou

Badia

Duteille

. Mycotic aneurysm of the left subclavian artery presented with hemoptysis in an immunosuppressed man: case report and review of literature. J Vasc Surg. 1995;21:697–702.

14.

Vogt

Brunner-LaRocca

Lachat

. Technical details with the use of cryopreserved arterial allografts for aortic infection: influence on early and midterm mortality. J Vasc Surg. 2002;35:80–86.

15.

Coselli

Crawford

. Surgical treatment of aneurysms of the intrathoracic segment of the subclavian artery. Chest. 1987;91:704–708.