Aberrant right subclavian artery in focus: 15-month results after a hybrid intervention

Excerpt

The arteria lusoria (AL), also commonly known as the aberrant right subclavian artery (ARSA), is the most prevalent congenital aortic arch anomaly and is found in approximately 0.9–2% of the population [17]. Historically, AL was first documented by Hunauld in 1735 [8]. Bayford later associated AL with dysphagia, coining the term dysphagia lusoria [2]. Kommerell named the diverticulum of AL Kommerell’s diverticulum (KD) [12]. It is believed that the embryonic origin of the AL arises from a deviation in the involution of the fourth right aortic arch, which typically develops into the right subclavian artery [18]. Typically, the AL traverses the thorax either posterior to the esophagus (80–84%), between the esophagus and trachea (12.7–15%), or anterior to the trachea (4.2–5%) [7]. Normally, the AL is asymptomatic but can cause symptoms such as dysphagia lusoria, dyspnea, chronic cough and hoarseness; furthermore, it can lead to the development of arterioesophageal or arteriotracheal fistulas due to tracheal and esophageal compression [6, 14]. An aneurysmal dilation of the AL can lead to serious complications such as rupture and embolization [10, 11] and even AL without aneurysmal dilation can also lead to distal embolization [1]. This article delves into the clinical decision making and operative approach in the treatment of an AL aneurysm measuring 4.4 cm, posing a risk of rupture. We outline the two-stage surgical strategy and discuss the postoperative outcome, supplemented by a 15-month follow-up. Both the surgical and clinical examinations were conducted at Bad Oeynhausen Hospital in Germany. …