Surgical treatment of subclavian artery aneurysm due to fibromuscular dysplasia.

Abstract

Subclavian artery aneurysm (SAA) is a rare and potentially life and limb-threatening disease. Fibromuscular dysplasia (FMD) is an idiopathic, segmental, non-atherosclerotic and non-inflammatory disease of the musculature of arterial walls, leading to stenosis of small- and medium-sized arteries. We are presenting a case of surgical treatment of SAA due to FMD with compression symptoms. A 63-year-old woman was admitted due to an 18-mm right SAA. She complained of constant pain in the right shoulder. Due to the significant compression symptoms, risk of rupture, embolization and thrombosis, surgical treatment was indicated. The aneurysm was isolated through the supraclavicular incision and resected with subsequent subclavian artery (SA) reconstruction. Histopathological findings showed FMD, with thickened intima and fibroplasia of the subintimal layer of the arterial wall and luminal nodular formation as a striking feature, with tunica media being atrophic and replaced by fibrous tissue. The postoperative course was uneventful, and after 6 months, the patient was doing well with SA flow well preserved and no more pain in the right shoulder. SAA due to FMD is rare. Surgical treatment in such cases is the preferable treatment option over endovascular, due to the relief of aneurysmal sac compression symptoms on surrounding nerves and structures. In the case of isolated subclavian artery pseudoaneurysm, one should suspect that the cause could be FMD.