Int J Angiol 2013; 22(01): 069-074
DOI: 10.1055/s-0033-1333862
Case Report
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Subclavian Aneurysm Presenting with Massive Hemoptysis: A Case Report and Review of the Literature

Hilary A. Brown
1   Department of Vascular Surgery, Yale University School of Medicine, New Haven, Connecticut
,
John E. Aruny
2   Department of Interventional Radiology, Yale University School of Medicine, New Haven, Connecticut
,
John A. Elefteriades
3   Department of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Connecticut
,
Bauer E. Sumpio
1   Department of Vascular Surgery, Yale University School of Medicine, New Haven, Connecticut
› Author Affiliations
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Publication History

Publication Date:
05 February 2013 (online)

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Abstract

We present a case of a 70-year-old male with a past medical history of coronary artery bypass grafting and end stage renal disease who presented with massive hemoptysis. He had a history of methicillin-resistant Staphylococcus aureus endocarditis, with infection and removal of endocardial pacing leads. His work-up revealed a 2.9-cm proximal left subclavian artery aneurysm. Bronchoscopy confirmed bright red blood in the left upper lobe bronchus and coronary angiography confirmed a patent left internal mammary artery (LIMA) to left anterior descending bypass. Because of the consideration of maintaining coronary perfusion via the LIMA while excluding the subclavian aneurysm, he underwent a left carotid to left axillary artery bypass graft followed by deployment of an Amplatzer II vascular plug just distal to the aneurysm. A thoracic endograft was then deployed to exclude the origin of the subclavian. A review of the literature reveals hemoptysis as a rare presentation of a subclavian aneurysm. We discuss approaches to this challenging clinical problem, ranging from open repair to hybrid approaches.