[A case of successful repair of a left subclavian arterial aneurysm ruptured into the esophagus--review of 89 cases in Japan].

This report concerns a case of a left arteriosclerotic subclavian arterial aneurysm ruptured into esophagus. A 61-year-old man who complained of fever, dyspnea, and dysphagia was diagnosed by chest X-ray, selective left subclavian arteriogram, and chest CT. Because he vomited a large amount of blood before an operation, we suspected that the aneurysm had ruptured into the esophagus, and therefore performed an emergency operation. The operative procedure consisted of exposing the aneurysm through a median sternotomy incision with the addition of a left supraclavicular incision, proximal and distal ligation, and reconstruction of blood flow by an aorto-left subclavian artery bypass with a Gore-tex prosthetic graft; however the aneurysm was not resected because of adhesion to the surrounding tissues. The post-operative course was uneventful and the patient is now normal and back at work, 2 years after the operation. Subclavian arterial aneurysms are relatively rare among peripheral arterial aneurysms. The common causes of subclavian aneurysms are arteriosclerosis (18%), trauma (14.6%), non specific inflammation (13.5%), and thoracic outlet syndrome (11%). Of the only 15 ruptures in 89 cases that have been reported in Japan, none have ruptured into the esophagus. Subclavian artery aneurysms represent a risk of rupture or peripheral circulatory failure, and consequently, should be considered for surgical treatment.