Hybrid Approach for Arteria Lusoria Aneurysm

Keywords

Aberrant right subclavian artery - Arteria lusoria - Aneurysm - Hybrid

Background: The arteria lusoria is the most common congenital anomaly of the aortic arch. When aneurysmal degeneration occurs, patients often exhibit symptoms such as dysphagia, dyspnea, and arm claudication. Advancements in thoracic endovascular aneurysm repair (TEVAR) have offered a feasible option for patients who would otherwise face significant morbidity risks with traditional open surgery.

Methods: This is one case report about a symptomatic aberrant right subclavian artery aneurysm treated by bilateral carotid-subclavian bypasses, both subclavian arteries embolization and thoracic endovascular aneurysm repair

Results: We present the case of an 89-year-old man experiencing chest tightness and dyspnea. A thoracic computed tomography angiography revealed a 40 mm aberrant right subclavian artery aneurysm (arteria lusoria). This artery originates as the final branch of the aortic arch on the left side of the thorax, passing behind the esophagus and trachea. Patient’s general condition was good. Because of the symptoms and the risk of rupture, treatment was needed. It proceeded in two stages. For the first step, a right prosthetic carotid-subclavian bypass was performed through a supraclavicular approach. For the second step, a left prosthetic carotid-subclavian bypass through a supraclavicular approach was followed by both subclavian arteries percutaneous embolization and percutaneous TEVAR. Postoperative computed tomography angiography demonstrated patent bilateral carotid-subclavian bypasses and no endoleak.

Discussion: The symptomatic aberrant right subclavian artery and its associated aneurysm should be excluded post-diagnosis. Due to the patient's age, open surgery included high risk, so we opted for a less invasive hybrid technique without sternotomy. While this approach offers advantages over open surgery, it's uncertain if exclusion alone effectively treats symptomatic patients versus resection. Recent reports on the hybrid approach suggest symptomatic relief for most patients, likely due to aneurysm sac decompression by excluding arterial inflow and outflow.

Fig. 1

LCCA: Left common carotid artery

RCCA: Right common carotid artery

LSA: Left subclavian artery

RSA: Right subclavian artery

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
11 June 2024