Institution of cardiopulmonary bypass in an awake patient for resection of isolated intrathoracic right subclavian artery aneurysm causing near total compression of the trachea

The subclavian artery’s intrathoracic segment is a rare peripheral artery aneurysm site. Common causes are atherosclerosis, trauma, vasculitis, and infection. Subclavian artery aneurysms have a higher propensity for rupture, thrombosis, embolization, and compression of surrounding structures, thus necessitating urgent surgical care. Herein, we describe a case of isolated intrathoracic right subclavian artery aneurysm presenting with orthopnea and hoarseness due to near total tracheal compression and recurrent laryngeal nerve compression. We also describe in detail the necessary preparation for and use of pre-anesthesia cardiopulmonary bypass for surgical excision.