Aberrant right subclavian artery: a novel approach and an overview of operative techniques

Abstract

An aberrant right subclavian artery (ARSA) is a rare variation of normal anatomy occurring in 0.5% to 1.8% of the population. No current guidelines are available regarding ARSA management, and surgical intervention should be evaluated carefully. Moreover, symptomatic patients with a dominant left arch and aberrant ARSA require a surgical approach from the right side of the chest for ligation and division of the aberrant artery at its origin on the aorta. The ARSA can then be reimplanted onto the right common carotid artery via a supraclavicular incision. The extensive mobilization in the chest allows for easy reimplantation in the supraclavicular region and eliminates reliance on the collateral circulation. Postoperative monitoring is reliable and easy with radial pulse examinations.

Keywords: Aberrant right subclavian artery; Congenital cardiac surgery; Vascular surgery.

Fig 1

Three-dimensional reconstruction of a computed tomography scan. Blue arrow indicates the aberrant right subclavian artery (ARSA); green shading, the esophagus; and red shading, the pulmonary tree.

Fig 2

Preoperative computed tomography angiogram showing the aberrant right subclavian artery (ARSA) coursing posterior to and compressing the esophagus.

Fig 3

Intraoperative photograph showing the stapled end of the subclavian artery pulled through the chest, beneath the internal jugular vein.

Fig 4

Posterior view of postoperative computed tomography angiogram. Yellow arrow indicates the stump of the native origin of the ARSA at the aorta; and white arrow, the transposed subclavian artery to common carotid artery on the right. H indicates the direction of the head, F indicates the direction of the foot.