If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. You will then receive an email that contains a secure link for resetting your password
If the address matches a valid account an email will be sent to __email__ with instructions for resetting your password
Aberrant subclavian artery (ASCA) is rare in adults undergoing thoracic aortic surgery. Presence of an ASCA complicates operative management of thoracic diseases. Thoracic endografts (TEVAR) have expanded the treatment options in the field of thoracic aortic surgery. The present study evaluates the techniques and outcome of patients requiring management of an ASCA during surgery of the thoracic aorta in the TEVAR era.
Methods and Results
Since 2004, 22 adult patients were operated for the thoracic aorta and required management of an ASCA. Patients were managed and followed prospectively by a dedicated thoracic aortic team (mean follow-up: 3.1±2.4years). Table depicts patient characteristics and operative management. One and five year survival were respectively 94.7% and 82.9%. Three patients died at follow-up: one elderly patient whom required coil embolization of the ASCA developed an ASCA-esophageal fistula, a 30 yr old with traumatic rupture of the ASCA died of an aorto-esophageal fistula 3 months following TEVAR implantation and a 37 yr old Marfan patient required reoperation 4.6 yrs post-op for mitral disease and died of postoperative complications. Freedom from aortic related events at one and 5 years were respectively 84.2% and 61.8%. Six patients developed aortic related complications: two patients with esophageal fistula died, 2 patients are followed for distal type I endoleaks, one patient necessitated an open conversion for TEVAR infection and one patient required TEVAR re-lining for a type IV endoleak.
Conclusion
Presence of an ASCA complicates operative management of thoracic diseases. In presence of compression symptoms (dysphagia lusoria), an open approach should be favoured to relieve the obstruction in patients with acceptable open operative risks. TEVAR is a good option in complex aortic cases to exclude the proximal portion of the ASCA. Amplatz occluder inserted proximal to the vertebral artery offers a more reliable distal ASCA exclusion than the ‘classic’ coil embolization. TEVAR requires lifelong imaging surveillance to identify complications at an early stage and implement appropriate treatment.
30554-8&id=fx1.jpg){kind=link}