Outcomes in the treatment of aberrant subclavian arteries using the hybrid approach

Abstract

OBJECTIVES Aberrant subclavian artery is rare but one of the most frequent anatomical variations of the supra-aortic trunks. No consensus has been established on its best treatment. The aim of this study was to report the outcomes of aberrant subclavian artery treated by hybrid approach. METHODS This non-interventional retrospective multicentre analysis included patients treated for ASCA by hybrid approach in 12 French University Hospitals between 2007 and 2019. Hybrid approach was defined as endovascular procedure combined with open surgery or hybrid stent graft. Patients were divided in 4 groups (from less to more complex treatment). Primary end-point was 30-day mortality. Secondary end-points were 30-day complications and late mortality. RESULTS This study included 43 patients. Mean age was 65 (SD, standard deviation : 16) years. Symptoms were found in 33 patients. Subclavian revascularisation combined with aberrant subclavian artery occlusion was undertaken in 13 patients. Unilateral and bilateral subclavian revascularisation combined with thoracic aortic stent graft was undertaken in 11 and 6 patients, respectively. Total aortic arch repair combined with thoracic aortic stent graft was undertaken in 13 patients. Thirty-day mortality was 2.3% with a technical success rate of 95.3%. Thirty-day major postoperative complication rate was 16.3%: 4 strokes, 2 tamponades, 1 acute respiratory distress syndrome. Mean follow-up was 56.3 (SD: 44.7) months. Late mortality was 18.6%. CONCLUSIONS ASCA hybrid approach is feasible, safe and effective with low early mortality. Morbidity is rather high. However, it increases with the complexity of hybrid approach that should be kept as simple as possible if the anatomical morphology allows.