Outcomes of Complex Surgery for Lusoria Artery in Adults: A Multicenter Study

Background: Although an aberrant subclavian artery (aSA) is the most common congenital anomaly of the aortic arch, with a prevalence of only 0.5 to 2.2%, it is a very rare and surgically challenging disease. Patients can suffer from dysphagia and dyspnea, depending on the anatomical pathway and the severity, but usually it is discovered incidentally. Therefore, surgical treatment and outcome are not well investigated. Large-scale multi-center clinical trials do not exist, and there is paucity of reported studies in small single-center series. The aim of this study is to analyze, in a huge collective, the indications, surgical strategies, and outcomes after surgical treatment of an aSA with a multi-center study.

Methods: All patients who received invasive treatment for aSA between 1993 and 2024 were included in this retrospective international multicenter observational study (Germany, Switzerland, and Belgium). Patient-related data obtained from patients’ medical records were collected retrospectively in a local clinical database. Indications, surgical techniques, symptom improvement, and survival of patients undergoing surgery for aSA pathology were assessed.

Results: A total of 56 patients with aSA were identified, 30 (53.6%) of whom were male. The average age for the cohort was 50.8 ± 18.7 years. In 48 cases, the diagnosis was made via CT, 6 cases via MRI, and in 2 patients, no previous diagnostic was available. The most seen anomaly was right aSA at 73%. 45 of 56 (80%) were symptomatic. Planned aortic replacement was performed in 49 of 56 patients (87.5%). The other 7 surgical treatments were emergency cases. In 66% of cases, the repair was performed as a one-stage procedure. The surgical approach ranged from hemisternotomy (n = 3), full sternotomy (n = 28), and lateral thoracotomy (n = 19). In 11 patients, the aSA was treated interventionally. No intraoperative or interventional mortality was seen, and the in-hospital as well as the 30-day mortality rates were 5%. 48 patients could be followed up for more than 1 year, with an overall survival rate of 88%. Symptoms resolved in 25 of 45 cases.

Conclusion: Despite the rarity of an aSA and the different techniques according to the anatomy, outstanding results can be achieved based on the expertise of the surgery centers. Our study indicates that the surgical techniques used to treat ASA relieve symptoms with low rates of mortality.

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Artikel online veröffentlicht:
11. Februar 2025