Vascular Surgery Department, Meir Medical Center, Faculty of Medicine, Tel Aviv University, Kfar Saba, Israel.
Radiology Department, Meir Medical Center, Faculty of Medicine, Tel Aviv University, Kfar Saba, Israel.
Vasc Endovascular Surg. 2024 Feb;58(2):172-177. doi: 10.1177/15385744231203754. Epub 2023 Sep 27.
Aberrant right subclavian artery (ARSA) is the most common of the aortic arch anomalies, occurring in .5% to 1% of the population. There is no standardized follow up protocol, especially in the asymptomatic cases. The purpose of the present study was to evaluate the natural history of ARSA and the role of serial CT scans. This is a single-center retrospective study of patients with ARSA depicted on chest computed tomography (CT) scans between February 2013 and July 2022. Data were collected from their medical records. Measurements of the aorta at different segments including the aortic diameter at the orifice of ARSA, and ARSA at ostium followed by 1 cm intervals were collected, as well as for follow-up CT scans. 65 patients were diagnosed with ARSA, 70.8% of whom were women. The average age for the cohort was 58.569 ± 16.99 years. The median follow up time was 4 years (range 0-10 years), KM estimated survival after ARSA diagnosis at 1 and 5 years as 97% and 93%, respectively. Nineteen patients had a second CT scan and were included in the morphological CT dynamic analysis, on average of 29 ± 27 months apart (range 7-108). The mean ARSA diameter at origin was larger in the second scan 16.91 ± 4.31 mm compared to the initial scan 16.31 ± 4.96 mm, ( = .04).The mean aortic arch diameter in the first and second CT were 28.54 ± 4.24 and 29.64 ± 5.14 ( = .10), respectively. All other measurements did not disclose any significant enlargement over time. Our cohort demonstrate a benign natural history of ARSA with slow growth rates. However, due to our small sample size we can't draw a clinically sound recommendation on the need for imaging follow up, and further larger cohort with longer follow up interval are required.
异常右锁骨下动脉（ARSA）是主动脉弓异常中最常见的一种，在人群中的发生率为 0.5%至 1%。目前尚无标准化的随访方案，特别是对于无症状病例。本研究的目的是评估 ARSA 的自然史以及连续 CT 扫描的作用。这是一项单中心回顾性研究，纳入了 2013 年 2 月至 2022 年 7 月期间胸部 CT 扫描显示 ARSA 的患者。数据从病历中收集。收集了不同节段主动脉的测量值，包括 ARSA 开口处的主动脉直径和 ARSA 开口后 1cm 处的 ARSA，以及随访 CT 扫描。共诊断出 65 例 ARSA 患者，其中 70.8%为女性。队列的平均年龄为 58.569 ± 16.99 岁。中位随访时间为 4 年（0-10 年），KM 估计 ARSA 诊断后 1 年和 5 年的生存率分别为 97%和 93%。19 例患者进行了第二次 CT 扫描，并纳入形态 CT 动态分析，平均间隔 29 ± 27 个月（7-108 个月）。第二次扫描时 ARSA 起源处的平均直径为 16.91 ± 4.31mm，明显大于初次扫描时的 16.31 ± 4.96mm（ =.04）。第一次和第二次 CT 时的主动脉弓直径分别为 28.54 ± 4.24mm 和 29.64 ± 5.14mm（ =.10）。所有其他测量值在随访过程中均未发现明显增大。我们的队列显示 ARSA 的自然史为良性，生长速度缓慢。然而，由于我们的样本量较小，我们无法就影像学随访的必要性提出临床合理的建议，需要进一步进行更大样本量和更长随访时间的研究。
