Carotid Subclavian Bypass and Stent Grafting for Mycotic Pseudoaneurysm of Right Subclavian Artery

Background: The occurrence of mycotic pseudoaneurysms of the subclavian artery (SA) is rare. Only 3 cases of a combined open and endovascular treatment of true SA aneurysms have been reported. Conventional treatment for SA pseudoaneurysms is invasive thoracic surgery. Ours is a novel approach for mycotic pseudoaneurysm. Methods: A 72 year-old man with gastric cancer developed vocal cord paralysis because of a mycotic pseudoaneurysm of the right SA, after Hickman line insertion. Because of the close proximity between the pseudoaneurysm at the origin of the SA and the innominate and common carotid arteries, a combined endovascular and open carotid SA bypass was performed. Results: At 1-year follow-up, he recovered well, remained cancer-free, with resolution of the pseudoaneurysm. Both the anastomoses and stents remained widely patent. Conclusions: This case represents the first reported successful treatment of a mycotic SA pseudoaneurysm through a combined open bypass and covered stenting, with encouraging outcomes at 1-year follow-up.