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Table of Contents
LETTER TO THE EDITOR
Year : 2017  |  Volume : 18  |  Issue : 2  |  Page : 75  

Proximal flow control with a balloon during the treatment of left subclavian artery aneurysmsreply


1 Department of Cardiovascular Surgery, Istanbul Medical Faculty, Istanbul University Millet Caddesi, Capa 34390, Fatih, Istanbul, Turkey
2 Department of Radiology, Istanbul Medical Faculty, Istanbul University Millet Caddesi, Capa 34390, Fatih, Istanbul, Turkey

Date of Web Publication21-Jun-2017

Correspondence Address:
Murat Ugurlucan
Department of Cardiovascular Surgery, Istanbul Medical Faculty, Istanbul University Millet Caddesi, Capa 34390, Fatih, Istanbul
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/HEARTVIEWS.HEARTVIEWS_19_17

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How to cite this article:
Ugurlucan M, Beyaz MO, Oztas DM, Azamat S, Onal Y, Acunas B, Alpagut U. Proximal flow control with a balloon during the treatment of left subclavian artery aneurysmsreply. Heart Views 2017;18:75

How to cite this URL:
Ugurlucan M, Beyaz MO, Oztas DM, Azamat S, Onal Y, Acunas B, Alpagut U. Proximal flow control with a balloon during the treatment of left subclavian artery aneurysmsreply. Heart Views [serial online] 2017 [cited 2021 Mar 3];18:75. Available from: https://www.heartviews.org/text.asp?2017/18/2/75/208666

We read with a great interest the manuscript entitled, “Successful treatment of giant left subclavian artery pseudoaneurysm abutting the arch of the aorta and descending aorta” by Khan et al.[1] The authors presented treatment of a giant, most probably, mycotic pseudoaneurysm of the intrathoracic left subclavian artery through thoracotomy with an autologous pericardial patch. In addition, they mentioned about other treatment options briefly such as endovascular stent graft implantation [2] and ligation [1] with or without an anatomic/extra-anatomic bypass.

It is known that, in patients with proximal left subclavian artery aneurysms, the orifice of the subclavian artery may be very fragile.[1] It may be easily injured leading to catastrophic complications during surgical dissection. A balloon catheter placed prior to the surgery at the orifice of the left subclavian artery ready to be inflated in case of a rupture can be lifesaving. In addition, the balloon may also be used instead of a proximal arterial clamp.

Once again, we congratulate the authors for their successful treatment of a challenging left subclavian artery pseudoaneurysm; however, we believe that the operation could have been performed safer if a balloon catheter had been placed to the left subclavian artery orifice prior to the surgery.


   Reply Top


That is an excellent suggestion and we agree that the balloon occlusion of the left subclavian orifice is a safe option to get proximal control.[1],[2] However, that depends upon the ease with which one can gain proximal control on the arch of the aorta. Balloon occlusion in our case would have been an option if there was extensive inflammation on the arch of the aorta and the dissection to get proximal control on the arch was challenging. Fortunately, the inflammatory response around the aortic arch was not extensive and we were able to get proximal control on the arch of the aorta with partial occlusion clamp.

In case there was extensive inflammation, we were prepared to put the large Fogarty balloon through the descending aorta into the subclavian artery.

Dr. Hamza Abdur Rahim Khan

Medical College, Aga Khan University, Karachi, Pakistan


   References Top


  1. Ugurlucan M, Beyaz MO, Oztas DM, Azamat S, Onal Y, Acunas B, et al. Proximal flow control with a balloon during the treatment of left subclavian artery aneurysms. Heart Views 2017;18:76.
  2. Khan HA, Batool S, Khan FW, Fatimi SH. Successful treatment of giant left subclavian artery pseudoaneurysm abutting the arch of the aorta and descending aorta. Heart Views 2016;17:106.8.


 
   References Top

1.
Khan HA, Batool S, Khan FW, Fatimi SH. Successful treatment of giant left subclavian artery pseudoaneurysm abutting the arch of the aorta and descending aorta. Heart Views 2016;17:106-8.  Back to cited text no. 1
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2.
Alpagut U, Ugurlucan M, Tireli E, Rozanes I, Dayioglu E. Aorta after stent grafting for mycotic aneurysm. Arq Bras Cardiol 2011;97:e78-81.  Back to cited text no. 2
[PUBMED]    




 

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