A case study on surgical repair of subclavian artery aneurysm.

Bhuvaneshwari1*, Sripreethi2, Jayamenon3

1Criticalcare Nurse, Kauvery Hospital, Heartcity, Trichy, Tamil Nadu

2Nurse Educator, Kauvery Hospital, Heartcity, Trichy, Tamil Nadu

3Nursing Superintendent, Hospital, Heartcity, Trichy, Tamil Nadu

*Correspondence

Abstract

Subclavian artery aneurysm is a rare vascular condition that can lead to serious complications such as thrombosis, embolization, rupture, and compression of surrounding structures. Early diagnosis and prompt surgical intervention are essential to prevent morbidity and mortality. This case study describes the clinical presentation, diagnosis, surgical management, nursing care, and outcome of a patient who underwent subclavian artery aneurysm repair.

Keywords: Subclavian artery aneurysm; Aneurysm; Aneurysm repair.

Introduction

A subclavian artery aneurysm is an abnormal dilatation of the subclavian artery. It may occur due to atherosclerosis, trauma, infection, connective tissue disorders, or thoracic outlet syndrome. Patients may be present with pain, swelling, upper limb ischemia, or neurological symptoms due to compression of nearby structures. Surgical repair remains the definitive treatment for most symptomatic aneurysms.

Case Presentation

Age/Sex: 31-year-old male

Complaint: Swelling above the right clavicle with intermittent pain and numbness in the right upper limb for 2 months. Reduced arm endurance during activity

Clinical Finding

  • Pulsatile swelling over the right supraclavicular area
  • Decreased peripheral pulses in the right upper limb

Investigations

  • Doppler Ultrasonography
  • CT Angiography
  • Routine blood investigations
  • ECG and Echocardiography

Final Diagnosis: Right Subclavian Artery Aneurysm

Management

Medical Management

  • Antihypertensive medications
  • Antiplatelet therapy
  • Analgesics for pain management
  • Intravenous fluids
  • Monitoring of vital signs

Surgical Management

  • Subclavian Artery Aneurysm Repair
  • General anesthesia administered.
  • Aneurysm exposed through a supraclavicular incision.
  • Proximal and distal control of the artery obtained.
  • Aneurysmal segment excised.
  • Vascular reconstruction was performed using a synthetic graft.
  • Hemostasis achieved and wound closed in layers.

Nursing Management

  • Preoperative Care
  • Assess vital signs and neurovascular status.
  • Obtain informed consent.
  • Provide psychological support.
  • Maintain NPO status.
  • Prepare patient for surgery.

Postoperative Care

  • Monitor hemodynamic status.
  • Assess peripheral pulses and limb perfusion.
  • Monitor surgical site for bleeding or hematoma.
  • Administer prescribed medications.
  • Encourage deep breathing exercises.
  • Maintain fluid balance.
  • Provide pain management.
  • Educate patients regarding lifestyle modification and follow-up.

Discussion

Subclavian artery aneurysms are uncommon but potentially life-threatening vascular disorders. CT angiography is the gold standard for diagnosis and surgical planning. Surgical repair aims to prevent rupture and restore adequate blood flow. Postoperative nursing care plays a critical role in preventing complications such as graft occlusion, bleeding, infection, and limb ischemia. Early recognition and intervention contribute to favorable outcomes.

Outcome

  • Successful aneurysm repair performed.
  • Adequate distal limb perfusion maintained.
  • No postoperative neurological deficits.
  • Surgical wounds healed without infection.
  • Patient discharged in stable conditions with follow-up advice.

Conclusion

Subclavian artery aneurysm is a rare vascular emergency requiring timely diagnosis and treatment. Surgical repair provides effective management and prevents serious complications. Comprehensive perioperative nursing care is essential for optimal patient recovery and long-term outcomes.

References

  • Johnston, K. W., Rutherford, R. B., Tilson, M. D., Shah, D. M., Hollier, L., & Stanley, J. C. (1991). Suggested standards for reporting on arterial aneurysms. Journal of Vascular Surgery, 13(3), 452–458.
  • Dent, T. L., & Lindenauer, S. M. (1972). Aneurysms of the subclavian artery. Surgery, 72(1), 152–157.
  • Vierhout, B. P., Zeebregts, C. J., van den Dungen, J. J., Reijnen, M. M., & Vriens, P. W. (2010). Changing profiles of diagnostic and treatment options in subclavian artery aneurysms. European Journal of Vascular and Endovascular Surgery, 40(1), 27–34.
  • Witz, M., Yahel, J., Lehmann, J. M., & Shnaker, A. (1998). Subclavian artery aneurysms: A report of two cases and a review of the literature. Journal of Cardiovascular Surgery, 39(4), 429–432.

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