Ann Thorac Surg 2009;88:e8. doi:10.1016/j.athoracsur.2009.04.110
© 2009 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Aberrant Right Subclavian Artery Aneurysm in Coexistence With a Common Carotid Trunk
Michele Murzi, MDa,*,
Massimiliano Mariani, MDb,
Kaushal K. Tiwari, MDa,
Pierandrea Farneti, MDa,
Sergio Berti, MDb,
Jamshid H. Karimov, MDa,
Mattia Glauber, MDa
a Department of Adult Cardiac Surgery, "G. Pasquinucci" Heart Hospital, Massa, Italy
b Department of Interventional Cardiology, "G. Pasquinucci" Heart Hospital, Massa, Italy
* Address correspondence to Dr Murzi, Department of Adult Cardiac Surgery, "G. Pasquinucci" Heart Hospital, Fondazione CNR-Monasterio, Via Aurelia Sud, Massa, 54100, Italy (Email: michelem{at}ifc.cnr.it).
The coexistence of an aberrant right subclavian artery (ARSA) with a common carotid trunk (CCT) represents an extremely rare anomaly of the aortic arch. We have only found a couple of cases describing this anomaly in the literature [1, 2]. As with atherosclerotic aneurysm of the normal aortic arch, aneurysmal dilatation of the origin of ARSA requires early definitive intervention for the risk of rupture and dissection. Many open surgical techniques for the treatment of this condition have been reported [3], and recently endovascular stent graft procedures have been proposed as an alternative and less invasive treatment to surgery [4].
A 78-year-old man who is diabetic with severe chronic obstructive pulmonary disease was referred to our institution for dysphagia and a persistent cough that has recently developed. Chest computed tomographic scan revealed an aneurysmal dilatation of the origin of a retroesophageal ARSA (6.1 x 5.9 cm) in coexistence with a V-shaped CCT (Fig 1). The CCT arose as the first branch, followed by the left subclavian artery and the ARSA (Fig 2). The patient underwent hybrid surgical and endovascular repair. First, an axillary right carotid–axillary bypass was performed through a bilateral axillary incision and an upper partial sternotomy. Subsequently, a complete aneurysm exclusion was obtained with percutaneus endovascular stent graft deployment (36-French; Valiant, Medtronic Inc, Minneapolis, MN) through the right femoral artery. To prevent retrogade aneurysm reperfusion, we performed a percutaneus plug embolization (Amplatzer; AGA Medical Corp, Plymouth, MN) of the ARSA, distal to the origin of the vertebral artery. The patient had an uneventful recovery and was discharged home on postoperative day 6. A postoperative computed tomographic scan revealed complete aneurysm exclusion and patent bypass graft (Fig 3).
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References
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- Attmann T, Brandt M, Müller-Hülsbeck S, Cremer J. Two-stage surgical and endovascular treatment of an aneurysmal aberrant right subclavian (Lusoria) artery Eur J Cardiothorac Surg 2005;27:1125-1127.[Abstract/Free Full Text]
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