Endovascular Treatment of an Aberrant Right Subclavian Artery Aneurysm with Use of the Zenith Iliac Plug

Abstract

Aberrant right subclavian artery aneurysms are rare but demonstrate a propensity toward rupture; thus, early elective repair is mandated. Novel endovascular modalities are available to offer less-invasive treatment for a patient population with increasing comorbidities. We report a case of a 65-year-old woman with an aberrant right subclavian artery aneurysm causing dysphagia lusoria. The aneurysm was excluded proximally at Kommerell's diverticulum with a Zenith iliac plug and excluded distally by surgical ligation combined with a right carotid-subclavian artery bypass to preserve extremity perfusion.

Treatment of Symptomatic Aberrant Subclavian Arteries

“…Morris et al 22 occluded the orifice of the aberrant right subclavian artery using an Amplatzer Vascular Plug (St. Jude Medical, St. Paul, MN, USA) and added a carotid subclavian bypass via a supraclavicular incision. Similarly, Kedora et al 23 occluded the ASA with a Zenith iliac plug (Cook Medical). Using these hybrid techniques the plug could be positioned in the arterial segment which overlays the esophagus.…”

“…As a consequence, dysphagia could be persistent owing to compression by the plug itself. 14,23 Furthermore, the close proximity carries the potential risk for a subclavianeesophageal fistula, with its often fatal consequences. 24 In the authors' experience, a hybrid procedure using thoracic endovascular aortic repair with revascularization of the ASA is feasible because the ASA was excluded successfully in all patients.…”

Hybrid management of a ruptured right subclavian artery aneurysm dissection

“…Of these, only two referred to ruptured aneurysms, 8 , 9 and only one of these underwent repair. Twelve articles described hybrid or endovascular treatments for aberrant right subclavian artery aneurysms, 1 , 5 , 6 , 10 , 11 , 12 , 13 , 14 , 15 and the other 10 were unrelated to our topic. By exploring the bibliography of these papers, three others relevant to our research were found.…”

Cardiovascular dysphagia — anatomical and clinical implications

“…Carotid subclavian bypass, carotid subclavian transposition and ascending aorta to subclavian bypass were successfully performed [96]. An endovascular stenting of a lusorian artery aneurysm for the treatment of ARSA aneurysm at Kommerell's diverticulum has obtained good results [55]. During a 2-staged surgical procedure, transpositioning of the lusoria into the right common carotid artery was performed, followed by replacement of the distal aortic arch during a second session using a single-branched Dacron tube graft [90].…”