Endovascular repair and intrasac cefoperazone/sulbactam instillation for suspected Brucella-associated left subclavian artery pseudoaneurysm: a rare case report

Subclavian artery pseudoaneurysm is a rare disease and it etiology vary greatly, predominantly resulting from trauma or iatrogenic injury. Brucella -associated subclavian artery pseudoaneurysm is an exceptionally rare vascular pathology that presents significant diagnostic and therapeutic challenges. The lack of understandings poses challenges to prompt diagnosis and timely treatment. A 66-year-old male patient from a pastoral region presented with a 12-month history of progressive hoarseness and fatigue, with an asymptomatic pseudoaneurysm detected 15 months prior. He was diagnosed with a left subclavian artery pseudoaneurysm measuring 7.57 × 5.43 × 4.79 cm. Suspected of Brucella -associated pseudoaneurysm based on long-term pastoral exposure and imaging characteristics, the patient was successfully treated by endovascular stent-graft exclusion combined with adjunctive intrasac cefoperazone/sulbactam instillation. Eventually, systemic brucellosis was serologically confirmed post-discharge by the Center for Disease Control and Prevention (Serum Agglutination Test titer 1:160). The patient completed a 6-week oral dual antimicrobial regimen (doxycycline and rifampin), achieving complete symptom resolution at 9-month follow-up. Endovascular repair combined with adjunctive intrasac antimicrobial instillation is a feasible, minimally invasive strategy for patients who are at high surgical risk or decline open surgery with suspected Brucella -associated subclavian pseudoaneurysms. However, this adjunctive technique warrants further investigation, and mandatory prolonged systemic antimicrobial therapy alongside vigilant long-term surveillance remains essential. Not applicable.