Single-stage surgical repair in a complex case of aberrant right subclavian artery aneurysm and common carotid trunk (original) (raw)
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Annals of Vascular Surgery, 2011
The aberrant right subclavian artery (ARSA) aneurysm is rare; however, the risk of rupture and thromboembolism is high, with a postrupture mortality rate of 50%. In this report, we have described two cases of this anomaly. In the first case, a 62-year-old male patient presented with a symptomatic aneurysm of ARSA (maximum diameter of 4 cm) causing chest pain with dyspnea during moderate physical effort. Surgical treatment was performed with aneurysmal exclusion and direct anastomosis of the two heads of the subclavian artery. In the second case, a 72-year-old male patient presented with a symptomatic aneurysm (maximum diameter of 5.1 cm) of ARSA causing dysphagia and dysphonia. In this case, a one-stage hybrid treatment was performed: a bilateral carotidesubclavian bypass was associated with intentional occlusion of both subclavian arteries (by plug positioning) during thoracic endovascular stentegrafting procedures. In both cases, the peri/postoperative course was uneventful and the technical results in our series were excellent at long-term follow-up. Surgical treatment can be safely performed in patients with low operative risk or whenever endovascular technique is not suitable. The ARSA aneurysm, with appropriate anatomy, can be successfully treated by hybrid treatment (combined surgical and endovascular approach). We reckon that this minimally invasive technique helps avoid thoracotomy and could be the treatment of choice in high-risk patients.
Aberrant Right Subclavian Artery Aneurysm
The Annals of Thoracic Surgery, 1975
Ten patients with aneurysm of an aberrant right subclavian artery have been previously reported. Dysphagia is not commonly part of the initial symptomatology, and the diagnosis is usually established by chest roentgenogram, esophagogram, and aortography. If operative intervention is planned, adequate preparation for bypass and thoracic aortic grafting should be made since the aneurysm may also involve the descending thoracic aorta at the site of origin of the aberrant subclavian artery. Since both ischemia of the involved arm and the subclavian steal syndrome may occur after division of the origin of the subclavian artery, restoration of arterial flow in the distal subclavian artery is preferred. An additional patient is reported in whom right subclavian-to-carotid artery anastomosis was used after the subclavian artery aneurysm was removed.
Aberrant subclavian artery: Surgical treatment in thirty-three adult patients
Journal of Vascular Surgery, 1994
Because of the scarcity of large series in the literature, our experience with surgery for aberrant subclavian arteries (aSA) in adults was reviewed. Methods: During the last 16 years we have surgically treated 33 adult patients with aSA. Twenty-eight patients had a left-sided aortic arch with a right aSA whereas five had a right-sided aortic arch with a left aSA. Eleven patients (group 1) had dysphagia caused by esophageal compression by a nonaneurysmal aSA; five patients (group 2) had ischemic symptoms caused by occlusive disease of a nonaneurysmal aSA; 10 patients (group 3) had aneurysms of the aSA with or without symptoms caused by esophageal compression or arterial thromboembolism; and seven patients (group 4) had an aSA arising from a diseased (usually aneurysmal) thoracic aorta. In all cases the divided aSA was revascularized, most often by direct transposition into the ipsilateral common carotid artery. Nine of the 16 patients in groups 1 and 2 underwent operation with a cervical approach alone. In the remaining seven, the cervical approach was combined with a median sternotomy (six cases) or a left thoracotomy (one case). In the 17 patients in groups 3 and 4, either a cervical approach (two cases), a median sternotomy (four cases), or a two-staged approach combining a supraclavicular incision on the side of the aSA with a posterolateral thoracotomy on the side of the aortic arch (11 cases) was used. Aortic cross-clamping was required in 12 of these patients to perform the transaortic closure of the origin of the aSA with patch angioplasty (three cases), or prosthetic replacement of the descending thoracic aorta (nine cases). Cardiopulmonary bypass was used in six patients (including three with hypothermic circulatory arrest). Results: Four patients, all in groups 3 and 4, died after operation: two of multiorgan failure, one of heart failure, and one of esophageal rupture. Satisfactory clinical and anatomic results were obtained in the remaining 29 patients. Conclusions: The surgical approach to aSA must be flexible and adapted to the anatomic conditions found. We recommend routine reconstruction of the aSA to avoid ischemic complications in the vertebrobasilar territory or upper extremity. Provision should be made for cardiopulmonary bypass in patients with aneurysm of aSA or associated aortic aneurysm. a VASe SURG 1994;19:100-11.) Aberrant subclavian artery (aSA) is the most frequently encountered anomaly of the aortic arch and is found in approximately 0.5% of normal individuals. 1 It was described as an anatomic curiosity as early as 1735 by Hunauld. 2 In 1794 Bayford 3 was the first to recognize that aSA could be responsible for esophageal compression and dysphagia. In 1946 Gross 4 performed the first successful operation to correct tracheoesophageal compression caused by aSA in a child. Since then, several publications dealing with aSA, mostly reviews based on autopsy or radiologic series 5•9 or surgical series in children 10•12 have been published. Clinical or surgical studies on aSA in the adult have been limited to isolated cases or small series and have essentially focused on the diagnosis and approach to these lesions.
Aberrant right subclavian artery associated with common carotid trunk
2000
We have reviewed four cases of incomplete vas- cular rings caused by the presence of a common carotid trunk from which arose both carotid arteries associated with an aberrant right subclavian artery. The patients were aged between 3 and 9 months. All patients presented with recurrent respiratory tract infections. Three patients showed signs of malnutrition and failure to thrive caused
Simultaneous Hybrid Treatment of Aneurysmal Aberrant Right Subclavian Artery
Journal of Cardiac Surgery, 2014
We review the literature and report our experience on the simultaneous hybrid treatment (open and endovascular) of two symptomatic aneurysms of an aberrant right subclavian artery (ARSA). At followup (four years and one year, respectively) both patients were alive and free of symptoms. Hybrid treatment of an aneurysmal ARSA is a safe and effective procedure. However, a larger series of patients with long-term follow-up is necessary to determine the role of this technique.
Surgical approaches to the aberrant right subclavian artery
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2006
Aberrant subclavian artery (arteria lusoria) is a rare congenital anomaly that usually does not produce symptoms. Symptomatic patients require surgical intervention. The operative approach to correct this condition has been controversial. Herein, we describe surgical approaches to the aberrant right subclavian artery. From 2000 through 2004, 3 children and 1 adult with aberrant right subclavian artery underwent operation. Our surgical approach varied according to the age of the patient. A muscle-sparing right thoracotomy was used in the pediatric patients, and a supraclavicular approach was used in the adult. Patients were treated successfully by division of the aberrant right subclavian artery and translocation to the right common carotid artery, without graft interposition. There was no operative or late morbidity or death. Symptoms were completely relieved in all patients. Although an extrathoracic approach is applicable and reliable for adult patients, we believe that adequate e...
Aneurysm of the aberrant right subclavian artery - a case report
Polish journal of radiology / Polish Medical Society of Radiology, 2010
The right subclavian artery, originating not from the brachiocephalic trunk but directly from the aortic arch, is a rare anatomical abnormality. 'Arteria lusoria' is the accepted name of the retroesophageal right subclavian artery. Such a vessel location, between the vertebral column and the esophagus, determines its course to the right. This defect may be asymptomatic, found during autopsy or coincidentally during diagnostic procedures. However, it may also be symptomatic. The course of this major blood vessel in the limited anatomical space may cause symptoms of mediastinal organ compression. The aim of this paper was to present two cases of abnormal anatomical course of the right subclavian artery and its aneurismal dilation. In this study, CT scans of the saccular aneurysm of the retroesophageal right subclavian artery were used: of a male patient diagnosed at Euromedic Diagnostics in Olsztyn and of a female patient, from the resources of the Radiological Dept. at MSWiA ...