Proximal Flow Control with a Balloon during the Treatment of Left Subclavian Artery Aneurysms

© 2017 Heart Views | Published by Wolters Kluwer ‐ Medknow 75 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.