Stone William M, Ricotta Joseph J, Fowl Richard J, Garg Nitin, Bower Thomas C, Money Samuel R
Division of Vascular Surgery, Mayo Clinic, Scottsdale, AZ, USA.
Ann Vasc Surg. 2011 May;25(4):508-14. doi: 10.1016/j.avsg.2011.02.012.
Aberrant origin of right subclavian arteries represents the most common of the aortic arch anomalies. This variant has few published series to guide management. Our goal was to review treatment options and results for these potentially complex reconstructions.
A retrospective review was performed on all patients with a diagnosis of aberrant right subclavian artery at our institution between January 2003 and July 2009.
A total of 24 patients, which comprises one of the largest series reported, including 10 males and 14 females (mean age: 46.6 years, range: 7-77), were diagnosed with an aberrant right subclavian artery. Sixteen (66%) were diagnosed incidentally, but eight (33%) had symptoms of either dysphagia, upper extremity ischemia, or both. Computed tomography was most commonly used to establish the diagnosis (19 patients, 79%). Magnetic resonance imaging established the diagnosis in three patients (12%), upper gastrointestinal barium study in one (4%), and standard angiography in one (4%). A Kommerell's diverticulum (KD) was the most common associated anomaly (seven patients, 29%). All seven patients (100%) with a KD required intervention for either symptoms or aneurysmal degeneration. Intervention was performed in 10 patients (42%), including carotid subclavian bypass in five (50%), carotid subclavian transposition in three (30%), and ascending aorta to subclavian bypass in two (20%). Four patients (40%) had additional intervention for management of aneurysmal disease of the aorta or KD, with open aortic replacement in two (20%) and aortic endografting in two (20%). There was one perioperative death (10%) in a patient undergoing aortic arch debranching with placement of an aortic endograft. In all, 18 patients survived without symptoms after a mean follow-up of 38 months.
Aberrant right subclavian arteries are most commonly found incidentally with computed tomography. The presence of a KD seemed to correlate with the need for intervention. Patients with no symptoms with the absence of a KD can safely be followed.
右锁骨下动脉异常起源是最常见的主动脉弓畸形。关于这种变异的已发表系列研究较少，难以指导治疗。我们的目标是回顾这些潜在复杂重建手术的治疗选择和结果。
对2003年1月至2009年7月在我院诊断为右锁骨下动脉异常的所有患者进行回顾性研究。
共24例患者被诊断为右锁骨下动脉异常，这是已报道的最大系列之一，其中男性10例，女性14例（平均年龄：46.6岁，范围：7 - 77岁）。16例（66%）为偶然诊断，但8例（33%）有吞咽困难、上肢缺血或两者皆有的症状。计算机断层扫描最常用于确诊（19例患者，79%）。磁共振成像确诊3例（12%），上消化道钡餐检查确诊1例（4%），标准血管造影确诊1例（4%）。Kommerell憩室（KD）是最常见的相关异常（7例患者，29%）。所有7例（100%）有KD的患者因症状或动脉瘤退变均需干预。10例患者（42%）接受了干预，其中5例（50%）行颈动脉 - 锁骨下动脉搭桥术，3例（30%）行颈动脉 - 锁骨下动脉转位术，2例（20%）行升主动脉至锁骨下动脉搭桥术。4例患者（40%）因主动脉或KD的动脉瘤疾病接受了额外干预，2例（20%）行开放性主动脉置换术，2例（20%）行主动脉腔内修复术。1例接受主动脉弓去分支并置入主动脉腔内移植物的患者发生围手术期死亡（10%）。总体而言，18例患者在平均随访38个月后无症状存活。
右锁骨下动脉异常最常通过计算机断层扫描偶然发现。KD的存在似乎与干预需求相关。无症状且无KD的患者可安全随访。
