Hybrid Repair of a Kommerell's Diverticulum Aneurysm

Abstract   Aneurysms of the right aortic arch with an aberrant left subclavian artery are rare. We report the case of a 77-year-old woman with a Kommerell's diverticulum aneurysm, who underwent a successful hybrid repair, combining surgical off-pump bypass of the aortic arch vessels followed by endovascular aneurysm repair. (J Card Surg 2010;25:67-69)     

Aberrant Left Subclavian Artery Associated with a Kommerell's Diverticulum and a Left‐Sided Aortic Arch

Abstract Kommerell's diverticulum is most commonly associated with either an aberrant left subclavian artery from a right‐sided aortic arch or an aberrant right subclavian artery from a left‐sided aortic arch. We describe an exceedingly rare case of an aberrant left subclavian artery arising from a Kommerell's diverticulum in a patient with a left‐sided aortic arch, the “nonaberrant aberrant left subclavian artery.”(J Card Surg 2012;27:607‐608)     

Aortic Arch Aneurysm Associated with Arch Vessel Anomalies: Truncus Bicaroticus and Retroesophageal Right Subclavian Artery

Abstract   An atherosclerotic aortic arch aneurysm associated with a common origin for both carotid arteries is a rare condition. An aberrant right subclavian artery is just as rare, especially with a retroesophageal course. A combination of these two conditions, we believe, has never been reported.     

Aberrant Right Subclavian Artery Aneurysm

Ten patients with aneurysm of an aberrant right subclavian artery have been previously reported. Dysphagia is not commonly part of the initial symptomatology, and the diagnosis is usually established by chest roentgenogram, esophagogram, and aortography. If operative intervention is planned, adequate preparation for bypass and thoracic aortic grafting should be made since the aneurysm may also involve the descending thoracic aorta at the site of origin of the aberrant subclavian artery.Since both ischemia of the involved arm and the subclavian steal syndrome may occur after division of the origin of the subclavian artery, restoration of arterial flow in the distal subclavian artery is preferred. An additional patient is reported in whom right subclavian-to-carotid artery anastomosis was used after the subclavian artery aneurysm was removed.     

Open Thoracic Aortic Repair for Dysphagia in Patients with Kommerell's Diverticulum and Right-Sided Aortic Arch with Aberrant Left Subclavian Artery

Abstract   Kommerell's diverticulum of an aberrant left subclavian artery associated with a right-sided aortic arch is a rare congenital aortic anomaly. This communication reports two cases of this congenital anomaly leading to severe dysphagia. Both cases were successfully repaired with a staged open approach rather than an endovascular approach, which would not have addressed the presenting symptom of dysphagia. (J Card Surg 2010;25:62-64)     

Intrathoracic Aneurysm of the Right Subclavian Artery

Arterial aneurysms may occur in all arteries of the human body. Arteriosclerosis takes the first place in the aetiology of the aneurysms of the great arteries and lower extremities.

We would like to present a rare atherosclerotic aneurysm in the intrathoracic region of the right subclavian artery, in which vascular continuity was re-established by resection and direct end-to-end anastomosis instead of the generally used resection + revascularization technique with vascular grafts.     

Congenital Right Subclavian Artery Aneurysm: a Case Report

Aneurysms of the subclavian artery are unusual. The most common causes are atherosclerosis and trauma. We report one case of an elongated and tortuous right subclavian artery with an aneurysm involving the origin of the right vertebral artery. The patient underwent resection of the lesion with an end-to-end anastomosis of the subclavian artery and implantation of the right vertebral artery into the right common carotid artery. Results were consistent with a rare congenital subclavian aneurysm.     

Bilateral Subclavian Artery Aneurysm Associated with Idiopathic Cystic Medial Necrosis

Although cystic medial necrosis, either idiopathic or associated with Marian's syndrome, usually becomes manifest as an ascending aortic aneurysm, aortic insufficiency, aortic dissection, or a combination of these disorders, a rare case of bilateral subclavian artery aneurysm secondary to idiopathic cystic medial necrosis has occurred. Subclavian artery aneurysms most commonly represent poststenotic dilatation from anterior scalene or cervical rib compression, occasionally are associated with generalized arteriosclerotic peripheral vascular disease, and rarely are secondary to syphilitic or mycotic infections.Subclavian artery aneurysms have a major risk of rupture, embolus, or thrombosis, and therefore should be repaired. A reverse saphenous vein or prosthetic bypass graft from the carotid to the axillary artery provides adequate flow to the upper extremity. The aneurysm should be completely excised if possible, since reexpansion through small collaterals or through insufficient closure by ligation can occur and compress the brachial plexus after successful bypass. The clinical presentation, angiographic findings, and operative repair of a subclavian artery aneurysm secondary to cystic medial necrosis are described.     

Kommerell's Diverticulum, Risk Factor for Aortic Dissection

Abstract   A 54-year-old man presented with sharp chest pain and hypertension. He was treated with intravenous antihypertensive with good control of the blood pressure. Chest X-ray showed widened mediastinum, and subsequent computed tomography scan of the chest demonstrated dissection of the descending thoracic aorta. It also showed an aberrant right subclavian artery with retrograde extension of dissection and Kommerell's diverticulum, which is dilatation at the origin of the aberrant subclavian artery.     

Anomalous Right Subclavian Artery Arising Proximal to a Postductal Thoracic Aortic Coarctation

Approximately 1% of patients with postductal thoracic aortic coarctation have an associated anomalous right subclavian artery. Previous reports indicated that the aberrant right subclavian vessel arose distal to the coarctation site. The case of a patient is presented in whom the anomalous right subclavian artery originated proximal to the postductal coarctation. We believe this to be among the first reports of this entity. The embryological development pathway and clinical implications of this congenital defect complex are discussed.     

Surgical Treatment of Recurrence of an Aneurysm of Aberrant Right Subclavian Artery

A bstract A 52-year-old woman underwent incomplete resection of an aneurysm of the aberrant right subclavian artery. Three years later she was hospitalized because of a right superior mediastinal mass on the chest X-ray and a new angiography revealed dilatation of the remaining part of the aberrrant right subclavian artery near its origin and involving the adjacent thoracic aorta and the distal aortic arch. At surgery, a left posterolateral thoracotomy in the fourth intercostal space was performed. Using deep hypothermia and circulatory arrest the aneurysm was excised and the aortic tract adjacent to the aneurysm was replaced with a Dacron prosthesis.     

Arterioesophageal Fistula: A Rare Complication of Retroesophageal Subclavian Arteries

Formation of a fistula between a retroesophageal subclavian artery and the esophagus is a rare cause of hematemesis that is usually fatal. Several etiologies have been described. The purpose of this report is to describe a case involving successful surgical repair of an arterioesophageal fistula induced by prolonged nasogastric intubation. A preoperative CT scan under emergency conditions allowed tentative diagnosis. Arteriography in the operating room confirmed the presence of a fistula and also allowed temporary hemostasis by tamponade. On the basis of a review of the literature, this case demonstrates the importance of screening patients requiring prolonged nasogastric intubation to rule out the possibility of an aberrant aortic arch system.