Weiss Salome, Haligür Didem, Jungi Silvan, Schönhoff Florian S, Carrel Thierry, Schmidli Jürg, Wyss Thomas R
Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Interact Cardiovasc Thorac Surg. 2019 Sep 1;29(3):344-351. doi: 10.1093/icvts/ivz095.
Indications and techniques of repair for symptomatic or aneurysmal aberrant subclavian arteries (ASA) are controversial. This study analyses presentation, treatment and outcome of patients with symptomatic and/or aneurysmal ASA.
Retrospective analysis of consecutive adult patients undergoing symptomatic and/or aneurysmal ASA repair between January 2000 and June 2016.
Of 12 patients (4 females) with a median age of 66 years (range 24-75), 10 had right ASA and 2 had left ASA originating from a right aortic arch. Six patients (50%) had Kommerell's diverticulum and 6 patients had aneurysmal dilatation of the ASA itself. Six patients presented with symptoms (dysphagia n = 4, chest pain n = 1, recurrent aspiration n = 1). Nine patients (75%) were treated by open ASA resection/ligation with or without aortic repair. Three patients (25%) underwent hybrid repair using thoracic endovascular aortic repair to exclude the aberrant artery. ASA revascularization was achieved by subclavian-carotid transposition (n = 7), carotid-subclavian bypass (n = 1), aorto-subclavian bypass (n = 3) or reimplantation after aortic graft replacement (n = 1). Thirty-day mortality was 8% (n = 1). The median follow-up duration was 44 months (range 24-151). Symptoms were relieved in 4 and persisted partially in 1, while symptom relief remained unknown in 1 patient who died during follow-up. Imaging after a median of 34 months (range 2-134) after the operation showed patent ASA revascularization in all patients and no endoleaks in the hybrid group.
Surgical and hybrid repair allows satisfying results in patients with symptomatic and/or aneurysmal ASA. The optimal procedure has to be defined on an individual patient basis. Further studies, preferably with a multicentre approach, are required to answer more specific questions on the management of these patients and especially to assess long-term results following hybrid repair.
有症状的或动脉瘤样异常锁骨下动脉（ASA）的修复指征和技术存在争议。本研究分析有症状的和/或动脉瘤样ASA患者的临床表现、治疗及预后。
对2000年1月至2016年6月期间连续接受有症状的和/或动脉瘤样ASA修复的成年患者进行回顾性分析。
12例患者（4例女性），中位年龄66岁（范围24 - 75岁），10例为右侧ASA，2例为起源于右主动脉弓的左侧ASA。6例患者（50%）有Kommerell憩室，6例患者ASA本身存在动脉瘤样扩张。6例患者出现症状（吞咽困难4例，胸痛1例，反复误吸1例）。9例患者（75%）接受了开放的ASA切除/结扎术，伴或不伴主动脉修复。3例患者（25%）接受了杂交修复，采用胸段血管腔内主动脉修复术以隔绝异常动脉。通过锁骨下 - 颈动脉转位（7例）、颈动脉 - 锁骨下旁路移植术（1例）、主动脉 - 锁骨下旁路移植术（3例）或主动脉移植置换术后再植入术（1例）实现了ASA血运重建。30天死亡率为8%（1例）。中位随访时间为44个月（范围24 - 151个月）。4例患者症状缓解，1例部分缓解，1例在随访期间死亡，其症状缓解情况未知。术后中位34个月（范围2 - 134个月）的影像学检查显示所有患者的ASA血运重建通畅，杂交组无内漏。
手术和杂交修复对于有症状的和/或动脉瘤样ASA患者可取得满意结果。最佳手术方式必须根据个体患者情况确定。需要进一步研究，最好采用多中心方法，以回答关于这些患者管理的更具体问题，尤其是评估杂交修复后的长期结果。
