Symptomatic or aneurysmal aberrant subclavian arteries: results of surgical and hybrid repair

Abstract

OBJECTIVES Indications and techniques of repair for symptomatic or aneurysmal aberrant subclavian arteries (ASA) are controversial. This study analyses presentation, treatment and outcome of patients with symptomatic and/or aneurysmal ASA. METHODS Retrospective analysis of consecutive adult patients undergoing symptomatic and/or aneurysmal ASA repair between January 2000 and June 2016. RESULTS Of 12 patients (4 females) with a median age of 66 years (range 24–75), 10 had right ASA and 2 had left ASA originating from a right aortic arch. Six patients (50%) had Kommerell’s diverticulum and 6 patients had aneurysmal dilatation of the ASA itself. Six patients presented with symptoms (dysphagia n = 4, chest pain n = 1, recurrent aspiration n = 1). Nine patients (75%) were treated by open ASA resection/ligation with or without aortic repair. Three patients (25%) underwent hybrid repair using thoracic endovascular aortic repair to exclude the aberrant artery. ASA revascularization was achieved by subclavian–carotid transposition (n = 7), carotid–subclavian bypass (n = 1), aorto-subclavian bypass (n = 3) or reimplantation after aortic graft replacement (n = 1). Thirty-day mortality was 8% (n = 1). The median follow-up duration was 44 months (range 24–151). Symptoms were relieved in 4 and persisted partially in 1, while symptom relief remained unknown in 1 patient who died during follow-up. Imaging after a median of 34 months (range 2–134) after the operation showed patent ASA revascularization in all patients and no endoleaks in the hybrid group. CONCLUSIONS Surgical and hybrid repair allows satisfying results in patients with symptomatic and/or aneurysmal ASA. The optimal procedure has to be defined on an individual patient basis. Further studies, preferably with a multicentre approach, are required to answer more specific questions on the management of these patients and especially to assess long-term results following hybrid repair.

Clinical Characteristics and Computed Tomography Findings in Adult Patients With an Aberrant Right Subclavian Artery: A Single-Center Retrospective Cohort Study

“…Our study has several clinical implications. First, unlike previous studies in which dysphagia was the most common symptom at the time of diagnosis, our symptomatic patients reported shortness of breath to be the most prevalent one 22–24 . This finding suggests that the absence of dysphagia should not rule out an ARSA.…”

“…First, unlike previous studies in which dysphagia was the most common symptom at the time of diagnosis, our symptomatic patients reported shortness of breath to be the most prevalent one. [22][23][24] This finding suggests that the absence of dysphagia should not rule out an ARSA. Second, we found that ARSA patients taller than 158 cm (62 in) had greater odds of symptoms.…”

Hybrid repair of aberrant right subclavian artery using open and endovascular techniques

“… 15 , 16 KD develops as an aneurysmal enlargement of the descending aorta at the aberrant vessel origin, with a 19% to 53% risk of dissection or rupture. 17 , 18 , 19 Our patient did not have concomitant KD, although the origin of her ARSCA was ectatic. The presence of a KD would not have altered our operative approach, because the TBE device would have excluded its origin.…”

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

“…The 4 postoperative strokes that occurred in this series (9.3%) were related to embolic events, 3 of which occurred after complex repair. In the literature, postoperative stroke rates varied between 2.6 and 16% and were likely related to aortic arch and SAT manipulations and/or to endovascular wires and device-related injuries [ 21–23 ]. Other studies do not report a postoperative stroke after ASCA hybrid repair [ 14 , 16 ].…”