Aberrant right subclavian artery aneurysm: an analysis of surgical options

Asymptomatic Giant Aneurysm of the Arteria Lusoria Treated by Debranching and Aneurysmal Resection

The aberrant right subclavian artery (ARSA, arteria lusoria) is the most common intrathoracic vascular anomaly, affecting up to 2% of the population. However, aneurysms of congenital anomalies are extremely unusual and often present with dysphagia, dysphonia, or dyspnea due to compression of the surrounding structures. We report a case of an asymptomatic 57-year-old male with chronic kidney disease who was incidentally found to have a large aneurysm of the ARSA on preoperative computed tomography for laparoscopic nephrectomy. Surgery is unequivocally warranted as these aneurysms are associated with a high risk of complications, including thrombosis, embolism, and rupture. We debranched the ARSA, followed by anastomosis to the right carotid artery through a right neck incision. Subsequently, aneurysmal resection was performed through left thoracotomy. The patient had an uneventful postoperative recovery and was asymptomatic during the follow-up.

Hybrid Approach of Ruptured Type B Aortic Dissection with an Aberrant Subclavian Artery in a Single Patient with Turner Syndrome: A Case Report

Turner syndrome, also described as 45, X, may present with most serious cardiovascular anomalies including risk of aortic dissection and rupture. In emergency situation, management for aortic dissection with complicated anatomy accompanying vascular anomaly is challenging. Here, we report a rare case of ruptured type B aortic dissection with aberrant subclavian artery and partial anomalous pulmonary venous connection in a Turner syndrome. Through right carotid-subclavian artery bypass and thoracic endovascular aortic repair, successful hybrid endovascular management correlated with a favorable result in this emergency situation.

Aberrant right subclavian artery presenting as tracheoesophagial fistula in a 50-year-old lady: Case report of a rare presentation of a common arch anomaly

A 50-year-old, woman with a 2-year history of progressive dysphagia and 2-month history of chronic cough was referred to our center in a state of generalized sepsis. Provisional diagnosis of carcinoma esophagus with tracheoesophagial fistula was made. Evaluation of the patient revealed an aberrant right subclavian artery with retroesophageal course with compression of the esophagus and trachea with fistulous communication in between. The patient was managed with medical stabilization and with feeding jejunostomy, but she succumbed to underlying severe sepsis. This presentation of aberrant subclavian artery at this advanced age rare and is therefore reported.

Hybrid Endovascular Repair of an Aneurysmal Chronic Type B Dissection in a Patient with Marfan Syndrome With an Aberrant Right Subclavian Artery

Abnormal aortic arch anatomy is relatively uncommon but most frequently involves an aberrant right subclavian artery. Rarely, it is associated with aneurysmal dilatation of a chronic type B dissection. Under such circumstances, the abnormal anatomy may complicate therapeutics options. Furthermore, controversy exists regarding the use of surgical or endovascular techniques in patients with aortic aneurysms and underlying arteriopathies. The current literature is limited with regard to reporting of the latter. We present a hybrid approach to repair such an aneurysm in a patient with Marfan syndrome. In a 2-stage procedure, involving initial supra-aortic bypass to all aortic arch branches, followed by endovascular stent graft deployment, the aneurysm was successfully excluded. There were no immediate complications and no evidence of endoleak at 3 months postoperatively, with thrombosis of the false lumen in the chest. By adapting hybrid open and endovascular techniques, complex thoracic aneurysms may be successfully treated in the short term in the presence of an underlying arteriopathy.

Aberrant right subclavian artery syndrome: a case of chronic cough

A young, otherwise healthy man had chronic cough of 16 months' duration. Evaluation revealed an aberrant right subclavian artery. Kommerell's diverticulum without aneurysmal degeneration was present. Imaging studies showed compression of the esophagus but not the trachea. Results of methacholine challenge test were negative for evidence of reactive airway disease, but suggested mild variable intrathoracic obstruction. While aberrant right subclavian artery syndrome most commonly involves dysphagia, our patient's only symptom was cough. Right subclavian artery to right common carotid artery transposition was performed, with oversewing of the subclavian artery stump to the left of the esophagus through a right supraclavicular incision. This treatment was curative, with complete resolution of symptoms.

Surgical treatment for aneurysm at the origin of an aberrant right subclavian artery

Atherosclerotic aneurysms at the origin of an aberrant right subclavian artery (ARSA) are extremely rare entities of congenital origin. We report a case of a 62-year-old man who presented with dyspnea and upper chest pain. The CT scan and digital subtraction angiography revealed a 7-cm aneurysm of an ARSA arising from Kommerell's diverticulum. Deep hypothermic circulatory arrest was instituted and a transaortic approach was used for closure of the origin of the aneurysm with a prosthetic patch. A Dacron graft was interposed between the right subclavian artery and the ascending aorta and the aneurysmal sac was resected. The patient had an uneventful recovery.

Arterio-esophageal communication from a ruptured aberrant right subclavian artery aneurysm. CT diagnosis

We report the computed tomography (CT) findings of an arterio-esophageal communication from an aberrant right subclavian artery aneurysm which had eroded into the esophagus. Pathologic correlation is provided. To our knowledge, this is the first CT demonstration of an aberrant right subclavian aneurysm causing a communication to the esophagus reported in the literature. Previously, one CT case of a left aberrant subclavian artery aneurysm that had ruptured into the esophagus, had been described. The characteristic location of the aberrant vessel with aneurysmal dilation and the presence of abnormal air identified within the wall of the aneurysm on CT, helped establish the diagnosis antemortem.