title: Proximal left subclavian artery aneurysm presenting hemoptysis, hoarseness, and diplopia: repair through partial cardiopulmonary bypass and perfusion of the left common carotid artery.
abstract: Isolated true aneurysm of the subclavian artery is rare and can rupture, thrombose, embolize, or cause symptoms by local compression. We describe a case of a 67-year-old man with proximal left subclavian artery aneurysm presenting with hemoptysis, hoarseness, and diplopia. These symptoms suggested that the aneurysm ruptured, that the left recurrent laryngeal nerve was compressed by it, and that its mural thrombus caused cerebral embolism. It was incidentally confirmed that the aneurysm grew at the rate of 1.31 cm/year, from 3.0 to 4.2 cm in diameter for 11 months, preciously measured in a computed tomography scan. The aneurysm was successfully repaired via partial cardiopulmonary bypass and separate perfusion of the left common carotid artery through cross-clamping the descending thoracic aorta and the aortic arch between the origins of the brachiocephalic artery and the left common carotid artery. Neither partial clamping of the aortic arch at the portion branching the left subclavian artery nor taping the aortic arch between the origins of the left common carotid artery and the left subclavian artery could be achieved.
authors.affiliation: First Department of Surgery, Gifu University School of Medicine, Gifu, Japan. h-takagi@cc.gifu-u.ac.jp
authors.forename: Hisato
authors.initials: H
authors.lastname: Takagi
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Mori
authors.forename: Yukio
authors.initials: Y
authors.lastname: Umeda
authors.forename: Yukiomi
authors.initials: Y
authors.lastname: Fukumoto
authors.forename: Kakunoshin
authors.initials: K
authors.lastname: Yoshida
authors.forename: Kuniyasu
authors.initials: K
authors.lastname: Shimokawa
authors.forename: Hajime
authors.initials: H
authors.lastname: Hirose
mesh_terms: D000368:Aged; D000783:Aneurysm / Q000150:complications* / Q000601:surgery*; D017542:Aneurysm, Ruptured / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D017536:Carotid Artery, Common; D004172:Diplopia / Q000209:etiology; D006469:Hemoptysis / Q000209:etiology; D006685:Hoarseness / Q000209:etiology; D006801:Humans; D008297:Male; D010477:Perfusion; D013348:Subclavian Artery