A rare presentation and management of thrombosis of an aberrant right subclavian artery related to thoracic outlet syndrome

Abstract

Objectives We present a case in which a 44-year-old female smoker with a complex medical and surgical history presented with acute upper limb ischemia. Methods The patient was diagnosed with thoracic outlet syndrome causing symptomatic thrombosis of an aberrant right subclavian artery associated with diverticulum of Kommerell. The patient had history of extensive surgeries and radiation in the right chest with fibrotic changes, so surgical dissection in the area was associated with significant risk of nerve injury. Therefore, revascularization of the arm was performed via carotid to brachial artery bypass with reversed saphenous vein and the thoracic outlet was decompressed with segmental clavicular resection. Results Patient has been symptom free for 3 years with patent bypass. Conclusions This case demonstrates a unique presentation of distal thrombosis of a symptomatic aberrant right subclavian artery related to thoracic outlet syndrome. The combined claviculectomy–vein bypass is a safe and efficacious surgical approach that provides durable relief.

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“…The thrombus disappeared and recurrence was prevented with the embolectomy and subsequent antiaggregant and anticoagulant agents. While the literature on aberrant subclavian artery supports surgical intervention, especially in severe symptomatic cases [26,27], major surgery was not required in our case. With the treatment plan, ischemia completely disappeared, her overall condition improved, and she was discharged.…”