Hybrid Repair of Symptomatic Aberrant Right Subclavian Artery and Kommerell's Diverticulum

Vucemilo, Ivica; Harlock, John; Qadura, Mohammad; Guirgis, Mina; Gowing, Robert; Tittley, Jacques G.

doi:10.1016/j.avsg.2013.04.016

Cited by 33 publications

(50 citation statements)

References 29 publications

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“…[20][21][22][23][24][25] In a recent systematic review collecting overall 31 endovascular or hybrid published cases for aneurysms on aberrant subclavian arteries, Yang et al 1 found that the hybrid approach, including thoracic stent grafting with distal subclavian ligation, was the most frequently used.…”

Section: Discussionmentioning

confidence: 99%

Results of aberrant right subclavian artery aneurysm repair

Verzini

Isernia

Simonte

et al. 2015

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

Results of aberrant right subclavian artery aneurysm repair

Verzini

Isernia

Simonte

et al. 2015

Journal of Vascular Surgery

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“…Commonly, this vessel passes behind the esophagus and rarely between the esophagus and the trachea or anterior to both of the structures. 3 When the origin of the vessel has sufficient dorsal aortic remnants, there is a condition called Kommerell diverticulum (KOD), an anomaly described for the first time in 1936 by Burckhard Friedrich Kommerell. 4 Although the majority of patients affected by ARSA with or without KOD are …”

Section: Discussionmentioning

confidence: 99%

“…3 This was the reason why an endovascular treatment was not considered for our patient (36 years old).…”

Section: E10 Case Reportsmentioning

confidence: 98%

“…These include symptomatic patients with an ARSA with or without KOD, or patients in whom the KOD aneurysmal degeneration is >3 cm. 3 The first surgical approach was performed by Gross in 1946: through a left thoracotomy he simply ligated and divided the aberrant artery. 6 Since then, several other approaches have been described, such as right thoracotomy, sternotomy, cervical and supraclavicular access.…”

Section: E10 Case Reportsmentioning

confidence: 99%

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Mediastinoscopy-assisted Treatment of an Aberrant Right Subclavian Artery

Varetto

Castagno

Trevisan

et al. 2016

Annals of Vascular Surgery

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Aberrant right subclavian artery (ARSA) is a rare congenital anomaly characterized by the origin of the right subclavian artery from the aortic arch distally to the left subclavian artery. We describe the case of a young patient with symptomatic ARSA treated by mediastinoscopyassisted ligation at its origin and subclavianecarotid transposition.The aberrant right subclavian artery (ARSA) is a rare congenital anomaly characterized by a retroesophageal course of the right subclavian artery, whose origin from the aortic arch is distal to the left subclavian artery. The majority of patients with ARSA are asymptomatic; however, this anomaly may cause a condition named dysphagia lusoria. CASE REPORTA 36-year-old woman was referred to our center for a history of progressively worsening dysphagia and severe loss of weight. The patient reported an initial dysphagia for solids which had started 2 months prior. This has recently progressed to a dysphagia for liquids as well. Both neurological and otolaryngology evaluations were negative for organic or functional swallowing impairments. Due to her malnourished conditions, parental nutrition was administered. Videofluoroscopy was then performed and demonstrated an external compression during bolus progression in the proximal zone of esophagus on the anterolateral left side of the esophagus. This finding was considered highly suggestive for an ARSA. A computed tomography angiography (CTA) confirmed the diagnosis of an 8-mm ARSA and also revealed the associated anomalous origin of the left common carotid artery from the innominate trunk (Fig. 1). Due to the significant symptoms, surgical intervention was then planned. Under general anesthesia, the patient was placed in the supine position. A sandbag was positioned in the midline behind her shoulders to achieve a better extension of the neck. Through a 6 cm right supraclavicular incision, we sectioned the clavicular head of the sternocleidomastoid muscle and the anterior scalene muscle, after identification of the phrenic nerve. This helped to expose the ARSA, the mammary artery, the thyreocervical trunk, and the right vertebral artery. Then, with the use of a mediastinoscope, we followed the proximal aberrant subclavian artery in the retroesophageal space until 1 cm from its origin off the aortic arch. After systemic heparinization, a curved Satinsky vascular clamp was placed at the origin of ARSA (Fig. 2A); then, we oversewed the proximal portion of this artery as close to its origin as possible with a 2 Mersilene suture and transected it. The distal portion of the right subclavian artery was trimmed and with a careful preservation of the right vertebral artery, an end-to-side anastomosis was made with the right common carotid artery with a polypropylene 6-0 (Fig. 2B). No intraoperative complications occurred. Her postoperative course was uneventful and she tolerated regular diet with immediate regression of her dysphagia. On second postoperative day, a Gastrografin transit confirmed the absence of any obstruction in the esoph...

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“…A more recent systematic review published in 2014 identified 31 reported cases of patients with ARSA who underwent endovascular repair (10 patients without an associated Kommerell's diverticulum and 21 patients with a Kommerell's diverticulum) . The authors reported that 7/31 patients (22.6%) had postoperative complications and three patients died with an overall 30‐day mortality of 9.7%.…”

Section: Review Of Literaturementioning

confidence: 99%

Simultaneous Hybrid Treatment of Aneurysmal Aberrant Right Subclavian Artery

et al. 2014

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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 follow-up (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.

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Hybrid Repair of Symptomatic Aberrant Right Subclavian Artery and Kommerell's Diverticulum

Cited by 33 publications

References 29 publications

Results of aberrant right subclavian artery aneurysm repair

Results of aberrant right subclavian artery aneurysm repair

Mediastinoscopy-assisted Treatment of an Aberrant Right Subclavian Artery

Simultaneous Hybrid Treatment of Aneurysmal Aberrant Right Subclavian Artery

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